An 18-year-old man from a rural area of Iran, Fars province, presented with fever of unknown origin (FUO) since 1 month prior to admission. On admission, temperature was 38.68C, blood pressure 110/70 mmHg, pulse rate 90 per min, and respiration rate 18 per min. Fever was double quotidian, and was accompanied by profuse sweating. Physical examination revealed a palpable spleen 3–4 cm below the left subcostal margin. There was neither lymphadenopathy nor hepatomegaly. Liver tests show a mild elevation in enzymes as follows: SGOT 49 Iu/L (up to 46 Iu/L), SGPT 50 Iu/L (up to 49 Iu/L), alkaline phosphatase 250 Iu/L (100–290 Iu/L), total protein 7.0 g/dL (5.5–8.0 g/dL), albumin 2.8 g/dL (3.2–5.6 g/dL), g-globulin 4.2 g/dL (2.2–3.5 g/ dL). Complete blood test shows a mild anemia as follows: hemoglobin 11.1 g/dL (13.5–17.5 g/dL), hematocrit 34.2% (41–53%), RBC count 3.89 3 1012/L (4.5–5.9 3 1012/L), WBC count 7.6 3 109/L (4.4–11 3 109/L), platelet count 282 3 109/L (150–450 3 109/L), reticulocyte count 2.1% (0.5–1.5%). C-reactive protein was 34 mg/dL, and erythrocyte sedimentation rate 51-mm/hr. Chest X-ray and electrocardiogram were normal. An abdominal ultrasound confirmed the splenomegaly. Tuberculin skin test and serological tests for syphilis, brucella, CMV, EBV, HIV, and hepatitis viruses were negative. Bone marrow aspiration revealed mild erythroid hyperplasia and a slight increase in eosinophil count; but the obvious finding in bone marrow was numerous Leishman bodies (amastigotes). Surprisingly, amastigotes were mostly in aggregates, forming different shapes resembling as follows: tear drop (Image 1A), clover leaf (Image 1B), ball (Image 1C), sunflowers (Image 1D,E), rossetes (Image 1F), ring and doughnut (Image 1G–I). Such aggregation has not been reported in lymph node aspiration or skin smears [1,2]. The patient received glucantim injections, which subsided the fever within the first week and splenomegaly regressed in the second week. The human stage amastigote is an obligate intracellular parasite, spherical, 2–5 lm in diameter, and displays a nucleus and kinetoplast. Human infection occurs by the bite of the Phlebotomus sandfly and injection of promastigote form into the subcutaneous tissue. They develop into the amastigote form and disseminate through the reticuloendothelial system. Visceral leishmaniasis (kala-azar) (VL) is caused by Leishmania donovani or Leishmania infantum [3]. In Iran, kala-azar mainly occurs in infants and children (infantile kala-azar) and shows a seasonal pattern, appearing from April to October with infection having taken in previous fall [3]. Children 1 to 4 years old are mainly affected. It occurs very rarely in adults. The clinical infection is characterized by chronic fever and hepatosplenomegaly. VL can rarely present with Evans syndrome [4]. The demonstration of the parasite is necessary for the diagnosis of kala-azar. The indirect fluorescent antibody and polymerase chain reaction tests and culture are also helpful in diagnosis. The treatment of choice is meglumine antimoniate (glucantime), given intramuscularly daily for 30 days (10 mg/kg of body weight). Residual spraying with DDT and use of mosquito nets during sleep are recommended to stop transmission by sandflies. VL occurs sporadically in the different geographic areas of Iran [3].