Pancreatoduodenal Tuberculosis: A Rare Site of a Common Disease

The most common site of abdominal tuberculosis (TB) is the ileocecal region. The duodenum and pancreas are rare sites of abdominal TB. It is usually observed in immunocompromised patients with miliary or disseminated TB. Pancreatoduodenal TB is often misdiagnosed as malignancy due to a lack of specific symptoms. Here, we present a case of a 55-year-old immunocompetent man having abdominal pain, bilious vomiting, weight loss, and high-grade fever for three months. Contrast-enhanced computed tomography of the abdomen showed a localized abscess with air foci in the pancreatic head and duodenopancreatic groove. Additionally, there was retroperitoneal lymphadenopathy and mild ascites. Upper gastrointestinal endoscopy revealed an ulceroproliferative lesion in the second part of the duodenum suspicious of a malignant tumor. However, the endoscopic biopsy showed epitheloid-like histiocytes, Langerhans type of giant cells, and granuloma formation suggestive of TB. The patient responded to antitubercular treatment and became symptom-free.