Asian Journal of Research in Infectious Diseases

Background: Kala-azar and hepatitis B may present with overlapping systemic and hepatic features, creating diagnostic uncertainty in paediatric patients.

Case Presentation: A 9-year-old boy presented with fever, cough, generalised weakness, weight loss, and loss of appetite for one month. Examination revealed malnutrition, severe pallor, mucosal petechiae, hepatomegaly, and marked splenomegaly. Laboratory evaluation showed pancytopenia, severe anaemia, elevated inflammatory markers, and raised transaminases, while investigations for tuberculosis, malaria, dengue, enteric fever, scrub typhus, HIV, and hepatitis C were negative. Hepatitis B surface antigen was positive, and subsequent testing showed high hepatitis B viral load with hepatitis B e antigen positivity. Fever persisted despite antibiotics for febrile neutropenia and doxycycline. Liposomal amphotericin B was initiated empirically, after which the patient became afebrile within 24 hours. Because fever and hepatosplenomegaly persisted in a non-endemic region, serum rK39 immunochromatographic testing was performed and returned positive, supporting a diagnosis of Kala-azar.: The patient improved clinically after liposomal amphotericin B and was discharged with a plan to complete therapy and undergo further liver assessment before antiviral treatment.

Conclusion: This case highlights that Kala-azar should remain a diagnostic consideration in prolonged fever with hepatosplenomegaly and pancytopenia, even outside endemic regions, particularly when coexisting hepatitis B complicates interpretation of hepatic dysfunction.