Isolated Hepatic Tuberculosis Masquerading as Hepatic Cystadenoma: A rare presentation

Background: Tuberculosis (TB) remains a global health issue, with an estimated 10 million new cases reported in 2019. While pulmonary TB is prevalent, extrapulmonary TB, including hepatic tuberculosis, poses significant challenges, particularly in immunocompromised individuals. Hepatic tuberculosis is rare, constituting about 3% of extrapulmonary TB cases and is often diagnosed in the context of miliary TB. Its diagnosis is complicated by non-specific symptoms and difficulties in differentiating it from other hepatic lesions on imaging. Case: A 46 years old female presented with moderate upper abdominal pain and weight loss over six months, with no gastrointestinal symptoms. Initial evaluations, including liver function tests and imaging, indicated cholelithiasis and a cystic hepatic lesion. A triphasic CT scan suggested a hepatic cystadenoma. Given the symptoms and the potential malignancy of the lesion, surgical resection was performed, revealing granulomatous inflammation on histopathology, confirming isolated hepatic tuberculosis. The patient was treated with a standard anti-TB regimen and showed significant improvement. Conclusion: Isolated hepatic tuberculosis can mimic malignancies such as hepatic cystadenoma, complicating diagnosis and treatment. Awareness of this rare presentation is crucial, especially in TB-endemic regions, to prevent misdiagnosis and unnecessary interventions. Early recognition and appropriate anti-TB therapy can lead to favorable outcomes, as demonstrated in this case.