A 37-year-old man presented with fever, abdominal discomfort and weight loss of 4 weeks duration. Examination revealed an ill-looking, emaciated patient with hepatosplenomegaly.

Complete blood counts, chest x ray, liver and renal function tests were normal.

Ultrasonography of the abdomen revealed multiple hypoechoic lesions in the spleen and liver. Computed tomography (CT) scan of the abdomen showed multiple, nodular, hypoechoic lesions in the spleen and liver, but no lymph node enlargement (fig 1). The possibilities of secondaries, lymphoma, tuberculosis and sarcoidosis were considered in view of the clinical and radiological findings.