Dengue-like presentation of acute viral hepatitis in an adolescent receiving antitubercular therapy: a case report.

INTRODUCTION AND

IMPORTANCE

Severe drug-induced liver injury, dengue, and viral hepatitis are important causes of acute liver dysfunction, but their co-occurrence in young patients is extremely uncommon and can create diagnostic challenges.

CASE PRESENTATION: We report a 15-year-old boy who developed severe acute hepatitis while receiving antitubercular therapy (ATT). He presented with fever, vomiting, and myalgias 4 weeks after starting ATT and was initially diagnosed clinically as dengue. Laboratory tests showed markedly elevated transaminases [aspartate aminotransferase (AST) 4172 U/l and alanine aminotransferase (ALT) 2139 U/l], hyperbilirubinemia (total bilirubin 2.03 mg/dl), and progressive thrombocytopenia. Dengue serology later returned negative, and further evaluation confirmed acute hepatitis A infection. Prompt withholding of first-line ATT and initiation of supportive care led to steady clinical improvement, with recovery achieved after 1 week.

CLINICAL DISCUSSION: The coexistence of acute viral hepatitis and tuberculosis in young individuals is rare and may be easily overlooked, particularly when a dominant clinical or laboratory abnormality directs diagnostic reasoning toward a single etiology. Such diagnostic overshadowing can delay recognition of concurrent pathologies, especially in resource-limited or high-burden settings where certain infections are more readily presumed.

CONCLUSION

This case underscores the importance of considering overlapping hepatotoxic triggers in young patients and highlights the need for timely, broad diagnostic evaluation.