Background <p>Tuberculosis (TB) of the abdomen is a rare form of extrapulmonary TB with indeterminate symptoms that are commonly mistaken for malignancies, leading to substantial diagnostic problems. This report describes the intricacies of diagnosing abdominal TB and emphasizes the need for sophisticated diagnostic instruments (such as molecular testing) in diagnosing abdominal TB when detection criteria are not specific on a clinical and radiological basis. It makes the need for a liberal diagnostic approach evident to avoid a misdiagnosis of the condition and timely treatment.</p> Brief summary <p>This case is about a 25-year-old female patient with abdominal pain, ascites, and weight loss. Primary investigations included imaging, analysis of ascitic fluid, and tumor markers that were not conclusive, and findings were suggestive of malignancy, but no final diagnosis could be made. Despite an extensive diagnostic workup that initially pointed towards malignancy, it was a focused omental biopsy that ultimately confirmed Mycobacterium tuberculosis via histopathology and GeneXpert molecular testing.</p> Conclusion <p>The patient was initiated on anti-tubercular therapy and scheduled for outpatient management, with subsequent clinical improvement observed.</p>