Case Report: Isolated hepatic tuberculoma mimicking malignancy in HBV-related chronic liver disease: a challenging case report

Abstract

Hepatic tuberculosis is a rare extrapulmonary manifestation of Mycobacterium tuberculosis infection. It can clinically and radiologically mimic primary hepatic malignancies, particularly in patients with underlying chronic liver disease. Herein, we report the case of an 81-year-old man with a history of compensated advanced chronic liver disease secondary to hepatitis B virus infection, treated with Entecavir, who presented with rapid clinical decline, weight loss, and a newly discovered hepatic mass. Imaging revealed a heterogeneous, necrotic lesion in segment IV, classified LR-M on LI-RADS, highly suggestive of malignancy. However, histopathology from a liver biopsy showed granulomatous inflammation with caseating necrosis, confirming the diagnosis of hepatic tuberculosis. No evidence of extrahepatic tuberculosis $ was found. The patient received a full 9-month course of anti-tuberculous therapy with complete clinical and radiological resolution. This case highlights the diagnostic challenge of hepatic tuberculosis in cirrhotic patients, especially when mimicking hepatocellular carcinoma or cholangiocarcinoma. Liver biopsy remains essential in atypical instances to avoid unnecessary interventions.