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We report the case of a 29-year-old male from the Indian subcontinent (a tuberculosis (TB)-endemic region) residing in Qatar, who presented with a three-day history of epigastric pain, dark urine, and pale stools. He had no known TB exposure, was HIV-negative, and had received the Bacillus Calmette-Guérin or BCG vaccination in childhood. Physical examination revealed scleral icterus without peripheral lymphadenopathy. Initial imaging showed a dilated common bile duct (CBD) (10 mm) and an overdistended gallbladder with sludge. Magnetic resonance imaging demonstrated conglomerated necrotic lymphadenopathy in the portacaval and precaval regions (the largest measuring 44 × 25 mm), causing smooth extrinsic compression of the distal CBD. Contrast-enhanced CT confirmed central necrosis with peripheral rim enhancement, favoring a tuberculous etiology over a malignant one. Endoscopic ultrasound-guided fine needle biopsy of the peripancreatic lymph nodes revealed necrotizing granulomatous inflam

“This is a development worth tracking. The clinical implications will become clearer as more evidence accumulates.”

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