Not All Pancreatic Masses are Cancer: Pancreatic Tuberculosis Masquerading as Malignancy.

Pancreatic tuberculosis (TB) is a rare extrapulmonary manifestation that can mimic pancreatic cancer. We report a 61-year-old man presenting with epigastric discomfort, weight loss, elevated liver enzymes, elevated carbohydrate antigen 19-9, and a pancreatic mass causing biliary obstruction. Endoscopic ultrasound-guided biopsies revealed granulomatous inflammation and necrosis. Autoimmune and fungal etiologies were excluded, and acid-fast stains were negative. Definitive diagnosis was achieved through 16S ribosomal RNA sequencing followed by detection of the Mycobacterium tuberculosis hsp65 gene. This case highlights the diagnostic challenge of pancreatic TB and the importance of reconsidering the differential diagnosis when histopathological findings do not align with clinical suspicion.