Twenty-seven out of five hundred and fifty three patients hospitalized for visceral leishmaniasis (Kala-azar) died during treatment with sodium antimony gluconate. Data from these patients were evaluated to find out the cause of death. Eight patients had associated diseases such as pulmonary tuberculosis (3), severe malnutrition (1), acute gastroenteritis (1), spleenic infarction (1), acute renal failure (1) and atrial septal defect (1) which could be attributed to death. Twelve patients developed spontaneous haemorrhages from nose, gums and gastrointestinal tract and died, despite of adequate supportive measures. Seven other patients who were improving slowly with antimony therapy died unexpectedly. Though, cause of death could be explained in some patients with associated disease conditions, it could not be explained in others as significant clinical manifestations, haematological, biochemical and electrocardiographic alterations were not evident prior to death. Our impression is that mortality in Kala-azar patients during standard antimonial therapy is more related to the drug rather than the disease process.