A female presented to the physician with a history of right upper quadrant pain. Abdominal computed tomography (CT) scan dem-onstrated a multi-loculated solid lesion in the head of the pancreas concerning for a primary malignancy. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the lesion was performed and cytology revealed no evidence of malignancy. The acid-fast bacilli culture was found to be positive for Mycobacterium tuberculosis complex and pancreatic tuberculosis was diagnosed.