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The risk of suffering opportunistics infections in the immunoincompetent patient is a fact perfectly established. An uncommon situation constitutes the bronchopaties, pathologies with a high prevalence among the general population that they require habitually, among other, steroid treatment. The immunosupression confers to the clinical evolution of the infections, as a consequence of the inadequate response to the physical stress, due to the inhibition of the hypothalamus-hypophysis axis being able to in particularly serious cases, to develop the denominated macrophage activation syndrome, a serious and uncommon syndrome that darkens the clinical prognosis in these patients. In presence of a feverish syndrome of uncertain origin in a patient in immunosuppressor treatment, although it is to low dose, it is necessary to carry out a exhaustive differential diagnosis, should consider, among them, the infection for Leishmania, a parasitosis whose incidence is increasing notably in the last years in the immunosuppressed population. We present the clinical case of a 63 year-old patient, immunoincompetent as a consequence of secondary chronic steroid therapy to asthmatic bronchopaty that experiences an uncommon form of visceral leishmaniasis in our area, consistent in multiorganic failure in the context of the development of a macrophage activation syndrome.

Keywords: automated hematology analyzer; complete blood cell count; mixed hyperlipidemia; white blood cell differential count.A 28-year-old male was first admitted to our emergency department with abdominal pain. His history of present illness consisted of nausea, vomiting and severe abdominal pain for 2 days. The patient stated he was diagnosed with type 2 diabetes mellitus 1 year previously; however, he was not on any regular medication. Admission laboratory studies of complete blood count (CBC) revealed a red blood cell (RBC) count of 4.82=10 6 /mL, white blood cell (WBC) count of 8.46=10 3 /mL, hemoglobin (Hb) of 186 g/L, hematocrit (Hct) of 39.1% and platelets of 202=10 3 /mL. WBC differential count revealed neutrophils at 63.5%, eosinophils 1.9%, basophils 0.2%, lymphocytes 15.4% and monocytes 19.0%. The serum chemistry including blood urea nitrogen, creatinine, sodium, potassium, chloride, aspartate aminotransferase, alanine aminotransferase, C-reactive protein and amylase were unremarkable except for lipase and glucose levels which were 84 U/L (normal range: 7-58 U/L) and 18.43 mmol/L (normal range: -6.1 mmol/L), respectively. Urinalysis showed glucose (4q), ketone bodies (3q) and protein (q). Manual differential count

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