Isolated Hepatic Tuberculosis Discovered Incidentally During Laparotomy for Gastric Perforation in an Immunocompetent Patient: A Case Report

Isolated hepatic tuberculosis is a rare clinical entity, particularly in immunocompetent patients. It is characterized by frequently silent symptoms and nonspecific radiological abnormalities, which complicates its diagnosis in the absence of specific clinical guidance. We present the case of a 39-year-old man with no significant medical history who was admitted to the emergency department with acute peritonitis resulting from gastric perforation. An exploratory laparotomy confirmed the prepyloric perforation and incidentally revealed the presence of two subcapsular hepatic nodules located in segment II. Histopathological analysis of liver biopsies revealed the presence of epithelioid and giant cell granulomatous inflammation, accompanied by caseous necrosis, strongly suggestive of hepatic tuberculosis. The staging assessment, which included a chest CT scan (showing no pulmonary lesions or mediastinal lymphadenopathy), and abdominal imaging, proved negative, reinforcing the diagnosis of isolated hepatic tuberculosis.The patient was placed on standard anti-tuberculosis treatment, with positive clinical results. This case highlights the importance of considering hepatic tuberculosis in the differential diagnosis of hepatic nodular lesions, even in immunocompetent patients, particularly in endemic areas. It also highlights the crucial importance of histopathological analysis in the diagnostic process and in the rapid adjustment of therapeutic management.