2nd August 2023

A 41 year old man presents with a 2 month history of fatigue, reduced appetite, weight loss and chills. He recently immigrated from Sudan.

A 41 year old man presents with a 2 month history of fatigue, reduced appetite, weight loss and chills. He recently immigrated from Sudan.

Examination reveals cervical lymphadenopathy and hepatosplenomegaly. You also note a different skin tone of his extremities, with his arms, hands and feet being considerably darker than the rest of his body. Blood tests show pancytopenia and globally elevated liver enzymes. A bone marrow aspirate comes back negative for haematological malignancies.

What is the most likely cause?

Select the SINGLE most appropriate option from the list below. Select ONE option only.