informed consent was obtained from the patient for publication of this case report and accompanying images . v. udayabhaskaran were involved in patient care and carried out the clinical assessment ; dr .
disseminated tuberculosis is an important differential diagnosis for fever of unknown origin ( fuo ) and it can present with hepatosplenomegaly and lymphadenopathy and may have meningitis and with hematological abnormalities including pancytopenia or a leukemoid reaction . 
 we report the case of a 13-year old male who presented with fever , weight loss , pallor and massive splenomegaly with pancytopenia , in whom a bone marrow trephine biopsy showed caseating granulomata , who responded well to antituberculous treatment and has remained healthy on follow up after nine years .