Objective Exploring the diagnosis and treatment experience of a patient with systemic miliary tuberculosis after hepatocellular carcinoma resection under the multidisciplinary team (MDT) model. MethodsThe clinical data of one patient who developed systemic miliary tuberculosis during immune-targeted therapy after hepatocellular carcinoma resection, admitted to The Second Affiliated Hospital of Chongqing Medical University, were retrospectively analyzed. ResultsThe patient was admitted with the complaint of “one-year history after surgery for hepatic malignant tumor, accompanied by newly-detected multiple systemic space-occupying lesions for one week”. The patient received transcatheter arterial chemoembolization and immune-targeted therapy previously. Following conversion therapy, the patient underwent right hemihepatectomy, cholecystectomy, omental lesion resection, gastric repair, inferior vena cava thrombectomy and intraperitoneal perfusion therapy. Immune-targeted therapy was performed after operation. Imaging studies demonstrated multiple occupying lesions. Laboratory studies showed tumor markers were at normal level. Sputum smear for acid-fast bacilli and T-cell spot test for tuberculosis were positive. After MDT discussion, systemic miliary tuberculosis was confirmed and extensive tumor metastasis was excluded. Individualized comprehensive therapy which based on anti-tuberculosis was initiated. After standardized treatment, the patient had symptomatic relief and nutriture improvement, imaging showed lesion absorption, and the patient was discharged in stable condition. ConclusionFor hepatocellular carcinoma patients receiving immune-targeted therapy, when tumor metastasis is excluded, atypical systemic miliary tuberculosis should also be noticed. MDT model is critical for accurate diagnosis and treatment scheme making.