Pancreatic tuberculosis presenting as an unusual head mass.

A 28-year-old man presented with upper abdominal pain accompanied by loss of appetite and weight. The clinical examination was unremarkable. His laboratory investigations revealed serum alkaline phosphatase of 260IU/l (normal range: 42–126U/L) with normal serum bilirubin. Ultrasound of the abdomen showed a well-defined hypoechoic mass, measuring 3cm, in the head and body region of the pancreas and a nondilated common bile duct and pancreatic duct. Integrated positron emission tomography (PET)–computed tomography (CT) had similar findings with the mass showing intense 18Ffluorodeoxyglucose (FDG) uptake (standardized uptake value [SUV] value of 15.7) and invading the common hepatic artery as well as the superior mesenteric vein (●" Fig.1). The peripancreatic and precaval lymph nodes were also enlarged and showed intense FDG uptake. Endoscopic ultrasound (EUS) also had similar findings, with infiltration of the major vessels by the mass (●" Fig.2). Following EUS-guided fine-needle aspiration from the mass, cytological analysis revealed granulomatous inflammation with negative staining for acid-fast bacilli (AFB) (●" Fig.3). The patient started four-drug antitubercular therapy (ATT) and showed a marked improvement in symptoms. After 6 weeks of ATT he is asymptomatic with a normal appetite and complete resolution of abdominal pain. Isolated pancreatic tuberculosis is very rare, closely mimicking pancreatic cancer both clinically as well as radiologically [1, 2]. It usually presents as a mass lesion in the head of the pancreas and mimics a resectable pancreatic cancer with no vascular involvement; therefore many patients have been diagnosed with pancreatic