We report a case of an Asian male renal allograft recipient who presented with acute liver failure. He had a fulminant course and succumbed to his illness. His postmortem study showed caseating granulomas in liver suggestive of tuberculosis (TB). Rest of organ systems did not show any evidence of TB. Miliary TB can have a rapid deteriorating course, but TB affecting only liver and causing liver failure sparing other organs has not been described.