When tuberculosis hides behind cancer: A challenging case of hepatopancreatic involvement and post-treatment fibrotic sequelae

Hepatopancreatic tuberculosis (HPTB) is a rare and often underdiagnosed form of extrapulmonary tuberculosis that presents with clinical and radiological features mimicking malignancy. We present the case of a 36-year-old male with no history of alcohol or tobacco use, who presented with elevated gamma-glutamyl transferase (GGT) levels during a routine check-up. Initial imaging, including abdominal ultrasound, CT scan, and MRI, revealed hepatic and pancreatic lesions that raised suspicion for metastatic disease. However, a liver biopsy confirmed the presence of granulomatous inflammation with caseous necrosis, consistent with tuberculosis. The patient was treated with a 12-month course of anti-tubercular therapy and anticoagulants for portal vein thrombosis. Follow-up imaging demonstrated partial regression of hepatic lesions and resolution of the pancreatic mass. However, the regression of the lesions led to retraction and fibrosis at the hepatic hilum, resulting in jaundice, which resolved after the patient underwent right hepatectomy. This case underscores the importance of considering HPTB in the differential diagnosis of hepatic and pancreatic masses, particularly in regions with high tuberculosis prevalence.