Visceral leishmaniasis, also known as kala-azar, is a vector-borne parasitic disease that can progress to a lifethreatening illness in immunocompromised individuals, especially those infected with HIV.

We report the case of a patient with HIV-1, initially diagnosed through pulmonary tuberculosis and under antitubercular and antiretroviral (ARV) treatment including Tenofovir, Lamivudine, and Dolutegravir, with good virological control (viral load was undetectable) and a CD4 count of 72 cells/mm³, presenting with pancytopenia associated with splenomegaly. The initial diagnosis was likely hematopoietic tuberculosis given the negative bone marrow aspiration and leishmaniasis serology. Nine months into well-managed treatment, the patient continued to have hematological disorders along with splenomegaly and hepatomegaly. Another bone marrow biopsy revealed leishmania bodies, leading to the diagnosis of visceral leishmaniasis. Treatment with liposomal Amphotericin B was started, resulting in a favorable clinical and biological outcome.