• Pi-Jiang Sun, Yan Lin, and Xi-Jun Cui.
• Department of Hepatobiliary Surgery, Weihai Central Hospital, Weihai, Shandong Province, People's Republic of China.
• Medicine (Baltimore). 2018 Dec 1; 97 (52): e13858.

RationalePrimary pancreatic tuberculosis is extremely rare, it presents with non-specific clinical symptoms and imaging features; it may be falsely identified as a malignancy of the pancreas.Patient ConcernsA 41-year-old male with no history of tuberculosis presented to our hospital with a 2-week history of jaundice.DiagnosesAbdominal computed tomography (CT) showed a heterogeneous irregular hypodense mass in the head of the pancreas causing dilatation of the common bile duct (CBD), and it was enhanced after infusion of contrast material. Serum cancer antigen (CA) 19-9 was 124 U/mL (normal: 0-40 U/mL). He was preoperatively diagnosed as having a pancreatic carcinoma.InterventionsA Whipple procedure (pancreaticoduodenectomy) was performed. The pancreatic tuberculosis was confirmed based on the postoperative histopathologic specimens and acid-fast stain of the drainage. Then isoniazid, rifampicin, and ethambutol were given for 6 months.OutcomesThe patient recovered very well. There was no evidence of tuberculosis recurrence, and the patient remained free of symptoms during the follow-up examination 1 year after surgery.LessonsPancreatic tuberculosis should be considered when the mass is located on the head of the pancreas even with elevated serum CA19-9 levels.

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