Fever, splenomegaly and pancytopenia may arise from a large range of infectious, hematologic or systemic diseases, and therefore represent a difficult diagnostic challenge. A possible cause of this syndrome is visceral leishmaniasis, an infectious disease due to intracellular protozoa of the genus Leishmania, which is endemic in many countries of both the Old and New World, but is quite uncommon in northern Italy. In particular, no "native" case of visceral leishmaniasis has so far been observed in the province of Verona. We present a case where the final diagnosis of visceral leishmaniasis was made in a 79-year-old man, who lived in Verona and had not traveled outside northern Italy for the previous 10 years. Clinical peculiarities, diagnostic difficulties and therapeutic regimens are discussed. We conclude that visceral leishmaniasis must be taken into consideration in the differential diagnosis of febrile splenomegalies even in geographical areas, such as northern Italy, where the infection is not endemic, and in patients without a suspicious travel history.