“…Serum hyperviscosity could manifest with bilateral sensorineural hearing loss. In the setting of massive splenomegaly, hyperviscosity may be related to the following: 1) high white cell counts, seen in chronic myeloid leukemia, 3 2) hematocrit, seen in polycythemia vera, 4 or 3) hypergammaglobulinemia, either monoclonal associated with Waldenstrom's macroglobulinemia, 5 or polyclonal associated with tropical infections (malaria and visceral leishmaniasis). 6,7 If left untreated, visceral leishmaniasis could cause bone marrow suppression (pancytopenia), immune dysfunction (recurrent bacterial infections), cachexia, hypoalbuminemia, edema, liver dysfunction (jaundice, ascites), renal impairment (proteinuria, hematuria, azotemia secondary to glomerulonephritis or interstitial nephritis), or bleeding diathesis (thrombocytopenia and liver dysfunction).…”