Background <p>Pancreatic tuberculosis (TB) is a rare extrapulmonary manifestation of TB, frequently mimicking pancreatic malignancy. Even in high TB-burden countries, its incidence is reported to be &lt; 5%. Meanwhile, TB has been increasingly recognized as a risk factor for venous thromboembolism (VTE), including pulmonary embolism (PE), due to systemic inflammation, hypercoagulability, and local vascular involvement. However, the occurrence of isolated pancreatic TB initially presenting with PE is exceptionally rare.</p> Case report <p>We report the case of a 50-year-old woman with no significant comorbidities who presented with acute right leg pain and swelling. Evaluation revealed deep vein thrombosis (DVT) and a computed tomography pulmonary angiogram confirmed extensive bilateral pulmonary embolism. Incidentally, an ill-defined mass was identified in the pancreatic head, raising suspicion for pancreatic carcinoma. Further evaluation with endoscopic ultrasound-guided biopsy demonstrated granulomatous inflammation consistent with tuberculosis.</p> Conclusion <p>This is, to our knowledge, the first reported case of isolated pancreatic TB presenting initially with pulmonary embolism.</p>