Liver Paradoxical Reaction Presenting as a Solitary Hepatic Mass During Antituberculosis Therapy: A Case Report

A vegan Indian woman in her late 20s was diagnosed with pulmonary tuberculosis. Imaging revealed a solitary hepatic mass five months after the initiation of antituberculosis therapy. Contrast-enhanced ultrasonography cannot distinguish between inflammation and malignancy. A biopsy revealed epithelioid cell granulomas without caseous necrosis, while a smear, culture, and PCR were negative. The therapy was continued without modification, and the hepatic lesion regressed within 7 months, consistent with a hepatic paradoxical reaction. This case illustrates that a new solitary hepatic mass emerging during antituberculosis therapy may represent a paradoxical reaction, and recognition of this entity may help clinicians avoid unnecessary regimen changes and invasive interventions, such as surgical resection.