Incidental Primary Hepatic Tuberculosis Mimicking Malignancy in a Patient With Hepatolithiasis: A Case Report of a Rare Surgical Condition.

Primary hepatic tuberculosis (TB) is an uncommon and diagnostically challenging condition, particularly in the absence of miliary or pulmonary disease. It can closely mimic hepatobiliary malignancies both clinically and radiologically, often leading to misdiagnosis and unnecessary surgical interventions. We report a case of a 45-year-old man who presented with right upper quadrant abdominal pain, fever, and jaundice. His medical history included open cholecystectomy with resection and anastomosis of the transverse colon, and endoscopic retrograde cholangiopancreatography for a choledochocolic fistula three years prior. Imaging revealed hepatolithiasis with left hepatic duct stricture and lobe atrophy, raising suspicion of malignancy. The patient underwent left lateral segmentectomy with ileal resection. Histopathological examination revealed nonnecrotizing granulomatous inflammation consistent with hepatic TB. Acid-fast bacilli staining was negative, and TB polymerase chain reaction could not be performed. The patient was started on antitubercular therapy and responded well. Given its rarity and nonspecific presentation, primary hepatic TB should be considered in the differential diagnosis of hepatic lesions in endemic regions. A high index of suspicion and the use of preoperative biopsy in equivocal cases can help avoid unnecessary surgical intervention and facilitate appropriate medical treatment.