Mistaking primary hepatic tuberculosis for malignancy: Could surgery have been avoided?

SummaryA 56-year-old woman presented with epigastric pain and loss of appetite and weight for the preceding 3 weeks. Clinically, she was jaundiced with upper quadrant abdominal tenderness. Initial blood tests and imaging scans suggested cholangiocarcinoma. Intraoperatively, no malignancy was observed. A frozen section biopsy suggested tuberculosis (TB). However, subsequent serological examination showed that the patient was nonreactive for human immunodeficiency virus, hepatitis B, hepatitis C, and acid-fast bacilli. A chest radiograph also showed no evidence of pulmonary TB. The patient was then placed on antitubercular therapy and her condition improved. Primary hepatic TB was not initially considered during diagnosis because of its low prevalence, but this led to performing an unnecessary surgery on this patient. We review the literature on this rare condition and discuss potential strategies for diagnosing and managing patients with primary hepatic TB.