Publication:

Hepatic non-caseating granulomas mimicking malignancy: a diagnostic dilemma of mixed infection

Hepatic granulomas present a diagnostic challenge due to their diverse etiologies, including infections, autoimmune disorders, and malignancies. In endemic regions, lesions with lymphadenopathy and metabolic activity on imaging often raise suspicion of malignancy or tuberculosis. We report a case of a 54-year-old female presenting with significant weight loss and multiple hepatic lesions with mesenteric lymphadenopathy, initially suggestive of malignancy. Histopathology revealed non-caseating granulomas, while microbiological investigations were negative. A multidisciplinary panel evaluation highlighted peripheral eosinophilia as a key clue, raising suspicion of a parasitic or mixed infectious etiology. Empirical antiparasitic therapy resulted in rapid resolution of hepatic lesions and normalization of eosinophil counts. This case emphasizes the importance of considering infections as malignancy mimics and highlights the role of clinical acumen and multidisciplinary evaluation in endemic settings.