Rare pseudotumoral hepatic tuberculosis mimicking malignancy: a diagnostic and therapeutic challenge

Pseudotumoral hepatic tuberculosis (TB) is an exceptionally rare manifestation of TB, often mimicking hepatic malignancy on imaging studies. We report the case of a 51-year-old female diagnosed with a low-grade tubulovillous adenoma of the ampulla of Vater, who presented with hepatic lesions initially suspected to be metastatic. Magnetic resonance imaging (MRI) revealed multiple hypointense lesions with heterogeneous enhancement and restricted diffusion. Histopathological examination of a liver biopsy confirmed the diagnosis of pseudotumoral TB. The patient underwent a 6-month course of antitubercular therapy, after which follow-up MRI demonstrated complete resolution of the hepatic lesions. This case highlights the importance of considering pseudotumoral hepatic TB in the differential diagnosis of hepatic masses, particularly in regions with a high prevalence of TB. Histological confirmation remains essential, and timely initiation of antitubercular treatment can result in excellent clinical outcomes. LEARNING POINTS: This case underscores the importance of including hepatic tuberculosis (TB), particularly its rare pseudotumoral form, in the differential diagnosis of hepatic masses, even in immunocompetent patients without pulmonary involvement or in non-endemic regions.Imaging findings alone may mimic malignancy, emphasizing the critical role of liver biopsy and histopathological analysis in achieving a definitive diagnosis and avoiding unnecessary surgical interventions.Recognizing atypical forms of TB is crucial for timely initiation of antitubercular therapy, which can lead to complete resolution and prevent potentially fatal complications.