A 73-year-old female patient, previously diagnosed with diabetes mellitus and hypertension, sought medical attention because of jaundice and abdominal pain. Abdominal CT scan revealed a periampular mass measuring 4,7cm at its longest axis and endoscopy confirmed a necrotic lesion in the duodenal papilla. Biopsy was performed and revealed adenocarcinoma, consistent with duodenal origin. Staging CTs revealed bilateral pulmonary nodules (1,5cm), raising the suspicion of metastatic disease (Figure 3). Lung biopsies (2 nodules) were performed, revealing chronic inflammatory granulomatous reaction with caseous necrosis (Figure 4). Ziehl-Neelsen staining was positive for acid fast bacilli, consistent with pulmonary tuberculosis. She started on anti tuberculous treatment, and was referred to surgery as a T4 N0 M0 duodenal adenocarcinoma.