US-guided aspiration was attempted, but the content was very thick that nothing was aspirated, so eight liver biopsies were taken from the right liver lobe lesion using a coaxial 18/16 G biopsy system.

The biopsies were sent for Ziehl-Neelsen (ZN) stain, acid-fast bacilli culture, polymerase chain reaction (PCR) for TB, and other routine microbiological investigations alongside histopathology.

TB PCR came positive the next day, histopathology showed necrotizing granulomatous inflammation. Diagnosis of TLA was made, and the patient was started on Anti-TB medications (isoniazid 300mg daily, rifampin 600mg daily, pyrazinamide 1750mg Q48 hours, ethambutol 800mg Q48 hours. After 3 days of starting the treatment, the patient started to improve clinically, evidenced by the absence of fever, gradual improvement of the abdominal pain and vomiting, and decrease in inflammatory markers.

The patient was discharged after 1 week from starting treatment, with regular follow-ups scheduled, he came back to the Infectious disease clinic after 1 month, with complete resolution of GI symptoms, and no recurrent fever, repeat US was not done as the patient was clinically improving.