Background : Pancreatic Tuberculosis presents a diagnostic challenge, often escaping early detection and appropriate management. A high degree of suspicion is needed to avoid subjecting patients to unnecessary diagnostics and surgical treatment.

Methods : Here, we report a case of a middle-aged woman who presented with a chronic history of right upper quadrant abdominal pain associated with jaundice and acholic stools, who was initially managed as a case of Choledocholithiasis however further work up revealed Pancreatic Head Malignancy hence was prepared for surgery. However intraoperatively, biopsy of incidental liver nodules and the pancreatic head mass revealed Hepatic and Pancreatic Tuberculosis, respectively.

Results : Open Biopsy with Frozen Section was done in this case. Intraoperatively, multiple whitish liver nodules were noted at segments 2 and 6, along with multiple palpable lymphadenopathies at perihilar area and pancreas. Frozen section biopsy of the liver nodule at segment 6 and Fine needle aspiration of the pancreatic mass revealed Chronic Granulomatous Inflammation with Caseation Necrosis Compatible with Hepatic and Pancreatic Tuberculosis, respectively.

Conclusions : This case accurately demonstrates how Tuberculosis can easily mimic Pancreatic Malignancy both radiologically and clinically despite the use of the most sophisticated imaging techniques available. Correct diagnosis can be made with certainty only with biopsy. Even though Pancreatic Tuberculosis is still rather a rare clinical entity. increased awareness is needed to avoid subjecting patients to unnecessary diagnostics and surgical treatment.