Beyond Bartonellosis: A Case Report of Hepatic Tuberculosis as a Final Diagnosis in a Child With Down Syndrome

Hepatic tuberculosis is a rare form of extrapulmonary manifestation. This case report depicts a 6-year-old boy with Down syndrome who presented with prolonged fever, weight loss, and hepatomegaly. The investigation revealed liver abnormalities suggestive of a granulomatous process, with the initial diagnosis of bartonellosis and, later, tuberculosis, with molecular testing and culture from a fragment of the liver biopsy. He underwent treatment and exhibited an excellent clinical response. This case highlights the importance of including hepatic tuberculosis in the differential diagnosis of liver diseases in children, even in the absence of evident pulmonary signs, especially in endemic regions including Brazil.