Isolated pancreatic tuberculosis presenting as mucinous cystic lesion

A young man in his early 30s presented to our hospital with upper abdominal pain radiating to the back, progressive jaundice with pruritus, low-grade fever, vomiting and significant weight loss over 4 months. The syndrome of extrahepatic biliary obstruction was considered. There was no significant past, personal or family history. Imaging was suggestive of mucinous cystic lesions of the pancreas with significant lymphadenopathy. He was initially planned for surgery. However, endoscopic ultrasound-guided fine-needle aspiration from the lesion tested positive for tuberculosis and he improved dramatically with antituberculosis therapy. When a patient has an atypical presentation, tuberculosis should always be considered, especially if they reside in a tuberculosis-endemic country.