Serologically supported pediatric brucellosis presenting with marked conjugated hyperbilirubinemia and marked...

Brucellosis is a multisystem zoonosis that can mimic complicated bacterial infection in children. A 10-year-old girl presented with prolonged high-grade fever, jaundice, abdominal pain, anorexia and weight loss. The initial syndrome was managed empirically as an undifferentiated complicated bacterial illness because enteric fever and a hepatobiliary or intra-abdominal source were considered. CRP was 333.2 mg/L and total/direct bilirubin 7.24/5.21 mg/dL despite only mild aminotransferase elevation; ultrasonography showed hepatomegaly and nonspecific gallbladder-wall edema without biliary dilatation or focal lesions. CRP peaked at 407.1 mg/L and began falling during meropenem-linezolid therapy before Brucella-directed treatment, so biomarker response was not used diagnostically. Re-taking the history revealed daily consumption of unboiled dairy milk for several months. On hospital day 6, doxycycline, rifampicin and gentamicin were started simultaneously, with discontinuation of meropenem and linezolid. Brucella serology was concordant: a laboratory-reported agglutination result labelled B. melitensis was reactive at 1:80 and later EIA showed strongly positive IgM and IgG, but neither test established species identity and culture/PCR confirmation was not obtained. Fever resolved by hospital day 14. At immediate post-treatment follow-up on 8 September 2026, she remained clinically well; weight had increased from 19 to 20 kg, CRP was 1.2 mg/L, total/direct bilirubin 0.8/0.2 mg/dL, AST/ALT 34/43 IU/L and alkaline phosphatase 417 U/L (within a published pediatric reference interval), with renal function within the laboratory reference range. Hemoglobin had improved to 7.8 g/dL with persistent microcytosis, before oral iron supplementation was initiated. The diagnosis is therefore best regarded as serologically supported pediatric brucellosis rather than microbiologically confirmed disease.