Pancreatic Tuberculosis Manifesting as Pancreatic Mass: A Case Report

Tuberculosis (TB) continues to be a major global health burden, particularly in low- and middle-income countries, where it contributes significantly to morbidity and mortality. While pulmonary TB is the most common form, extrapulmonary manifestations, including pancreatic TB, are rare and often pose diagnostic challenges. Isolated pancreatic TB in immunocompetent individuals is exceptionally uncommon and is rarely considered in the initial differential diagnosis of a pancreatic mass. We present the case of a 26-year-old immunocompetent woman with a six-month history of persistent epigastric pain, nausea, vomiting, and progressive weight loss. Laboratory investigations revealed normocytic normochromic anemia and mildly elevated serum bilirubin levels. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated pancreatic mass, leading to a provisional diagnosis of pancreatic carcinoma. However, histopathological examination of the lesion revealed features of an acute suppurative process. Further analysis of aspirated cystic fluid using the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) and Ziehl-Neelsen (ZN) staining confirmed the presence of Mycobacterium tuberculosis. The patient was commenced on standard anti-tubercular therapy, which led to marked clinical improvement. On follow-up, the patient's symptoms had resolved completely, and repeat imaging demonstrated normalization of pancreatic architecture. This case highlights the importance of considering pancreatic TB as a diagnosis, even in immunocompetent individuals, particularly from endemic regions. Limitations of our study include a short follow-up period and unavailability of endoscopic ultrasound (EUS) evaluation.