We report a case of a tuberculous pancreatic abscess in a 47-year-old human immunodeficiency virus positive intravenous drug abuser. She had a prolonged febrile course and persistent abdominal pain. On CT and sonography the lesion lacked the usual ancillary features of an abscess such as diffuse pancreatic enlargement and a peripancreatic fluid collection, and more closely resembled a necrotic neoplasm.