Leishmaniasis is thought to be rare in The Gambia but in June 1980 two patients with this infection were seen at Fajara, one with cutaneous leishmaniasis and one with visceral leishmaniasis. A possible diagnosis of visceral leishmaniasis was considered only late in the course of the illness of the second patient who died a few days after specific chemotherapy was started. Visceral leishmaniasis must be considered as a possible cause of fever and splenomegaly in The Gambia and in adjacent parts of West Africa.