Dear Editor,

A 48-year-old Ecuatorian male with no previous medical history was admitted to hospital due to acute cholangitis and wasting syndrome of a three-week duration. An abdominal ultrasound and a subsequent abdominal computed tomography (CT) identified a hypoattenuating nodule with a cyst-like appearance in the pancreatic head. The differential diagnosis was either an adenocarcinoma with a necrotic component or a cystic neoplasm. Thus, an endoultrasonography with fine needle aspiration (FNA) was performed (Fig. 1), which revealed an inflammatory granulomatous process with necrosis, giant cells, reactive plasmocytosis and neovascularization. After antibiotic therapy, the cholangitis was resolved and the laboratory tests normalized. However, the patient started to present a persistent fever, neurological and urological symptoms. The patient was finally diagnosed with disseminated tuberculosis (TB) with pancreatic involvement after a complete study with a mycobacterial culture in different media.

Fig. 1 A 20 mm hypoechoic mass in relation to the surrounding parenchyma in pancreatic head, causing an abrupt stoppage of the bile duct, can be observed. It is in intimate contact with the upper mesenteric vein in the confluence of the splenoportal axis without thrombose; it is difficult to rule out infiltration at this location.