“Dual Infection of Brucellosis and Abdominal Tuberculosis: An Unusual Cause of Febrile Jaundice

Abstract

Introduction:
Brucellosis and tuberculosis (TB) are important endemic infections in developing countries. Both conditions can present with overlapping systemic and abdominal features, making differentiation challenging. Clinically significant hepatic involvement with jaundice is rare in brucellosis, while abdominal TB often mimics other chronic infections. Co-infection of brucellosis and TB in a single patient is exceedingly rare and may lead to delayed or inappropriate treatment.

Case Presentation:

We report a 22-year-old male with type 2 diabetes mellitus who presented with high-grade fever for 15 days, jaundice for 7 days, right upper abdominal pain, vomiting, and watery diarrhea. Examination revealed icterus and hepatomegaly with right hypochondrial tenderness. Investigations showed thrombocytopenia (platelets 60,000/µl), elevated bilirubin (5.4 mg/dl), transaminitis (SGOT 383 IU/L, SGPT 266 IU/L), and elevated ALP and GGT. Brucella IgM serology was positive, while viral hepatitis, leptospirosis, and scrub typhus serologies were negative. Imaging demonstrated hepatosplenomegaly, bowel wall thickening, enlarged mesenteric lymph nodes, and ascites, highly suggestive of abdominal TB.

Conclusion:
This case emphasizes the diagnostic dilemma posed by overlapping features of brucellosis and TB. In endemic areas, physicians must consider co-infection in atypical presentations such as febrile jaundice. Rational therapy is essential to prevent mismanagement and reduce the risk of drug-resistant tuberculosis.