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.
Qumbar et al. (Tue,) studied this question.
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