Disseminated Tuberculosis Masquerading as Malignancy in an Immunocompetent Middle-aged Woman: A Multiorgan Imaging Case Report and Updated Review for Clinicians

Background Disseminated tuberculosis (dTB) can occur in immunocompetent adults, frequently mimicking metastatic malignancy, thereby delaying the diagnosis. Case presentation A young woman without known immunosuppression developed multisystem disease involving the peritoneum/ovaries, hepatobiliary structures, lymph nodes, adrenals, and thoracolumbar spine. CT/MRI and PET/CT suggested widespread neoplastic disease. Because FDG avidity is nonspecific, we prioritized histologic confirmation. Surgical exploration and targeted biopsies showed necrotizing granulomatous inflammation compatible with tuberculosis; microbiologic testing supported the diagnosis. The patient commenced directly observed first-line therapy (isoniazid, rifampin, pyrazinamide, ethambutol) as the intensive phase, followed by an isoniazid-rifampin continuation phase. Under treatment, symptoms improved, and interval imaging showed regression of inflammatory lesions. Conclusion In cancer-like, multisystem presentations, even in apparently immunocompetent hosts, tissue diagnosis is decisive, and imaging should primarily guide sampling. Early recognition and standardized therapy can prevent irreversible morbidity.