DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.053

Pages: 1091-1096

Background: Hepato-pancreato-biliary tuberculosis is a rare form of extrapulmonary tuberculosis, particularly in young immunocompetent patients. Its clinical and radiological presentation can closely mimic other conditions, most notably pancreatic malignancy, posing significant diagnostic challenges. Complications such as portal vein thrombosis and portal cavernoma further complicate its management, especially in resource-limited settings where advanced interventional procedures remain unavailable. Case Presentation: We report the case of a 21-year-old immunocompetent male who presented with a two-month history of jaundice, night sweats, and significant weight loss. Clinical examination revealed jaundice, a firm painless right cervical lymphadenopathy, hepatomegaly, and splenomegaly. Laboratory findings demonstrated thrombocytopenia, moderate hepatocellular injury, and a cholestatic pattern. Magnetic Resonance Cholangiopancreatography (MRCP) revealed a pancreatic head mass with peripancreatic fat infiltration, portal vein thrombosis, portal cavernoma, biliary dilation secondary to distal common bile duct stricture, and splenomegaly. An extensive infectious and autoimmune workup was negative. Histopathological examination the cervical lymph node confirmed tuberculosis. Upper gastrointestinal endoscopy identified grade III esophageal varices, managed with endoscopic band ligation and non-selective beta-blockers. Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement was considered but unavailable at our institution. The patient was started on the standard four-drug antituberculous regimen (HRZE) with no subsequent hepatotoxicity. Tragically, one month into treatment, and just prior to his scheduled second endoscopic band ligation session, the patient succumbed to a massive variceal hemorrhage. Conclusion: This case highlights the diagnostic complexity of hepato-pancreato-biliary tuberculosis and its potentially fatal course when complicated by severe portal hy