A patient with leishmaniasis presenting with longstanding pancytopenia and hepatosplenomegaly.

Leishmaniasis is a common cause of pancytopenia and hepatosplenomegaly in tropical and subtropical regions. A high index of suspicion is required to diagnose and manage patients with leishmaniasis. Travel history should always be elicited in a patient with suggestive clinical presentation.

Macro CK in patients with elevated troponin I levels.

CK-MB activity levels can be falsely elevated by the presence of macro CK, especially if immune-inhibition assays are used in the measurement. In patients with macro CK and cardiac pathology that could result in an elevated CK-MB activity, the diagnostic challenge lies in determining the true cause of the elevated CK-MB activity. We present two case reports of patients with elevated CK-MB activity and troponin I levels, but who subsequently had CK-MB activity higher than total CK activity, raising the suspicion of the presence of macro CK.