Pancreatic tuberculosis is a rare condition that may closely mimic malignancy. A 40-year-old woman presented with cholestasis and recent cholangitis. EUS revealed a heterogeneous hypoechoic pseudomass in the pancreatic head (32 × 25 mm) with confluent necrotic hilar lymph nodes compressing the bile duct and portal vein. EUS-guided biopsies showed chronic inflammatory changes with necrotizing lymphadenitis, without malignant cells. Based on clinical and imaging findings, a tuberculous origin was suspected and anti-tuberculous therapy initiated. Follow-up EUS demonstrated complete resolution of lymphadenopathies and regression of the pancreatic pseudomass, confirming the diagnosis. EUS with tissue acquisition is essential to differentiate tuberculous lymphadenitis from pancreatic malignancy, enabling curative medical therapy and avoiding unnecessary surgery.