Isolated Tuberculosis of the Pancreas: A Rare Differential Diagnosis of a Pancreatic Mass

Abstract

Pancreatic mass and fever: think of pancreatic tuberculosis as a rare differetial diagnosis. A 40-year-old previously healthy Albanian woman presented with abdominal pain, fever and recurrent vomitus for 1 month. Upper GI endoscopic evaluation revealed a prominent major duodenal papilla with granulomatous inflammation and lymphangiectasia. A huge pancreatic tumor with probable local infiltration and peripancreatic lymphomas was found by means of ultrasound/CT. Besides pancreatic cancer, non-Hodgkin's lymphoma and tuberculosis were considered in the diagnostic workup. T-spot was positive and chest X-ray was normal. Sputum was negative for acid-fast bacilli (AFB) and TB-specific PCR. Laboratory findings showed mild anemia, minimally elevated CRP and liver enzymes, and a normal CA 19-9. Serologies for hepatitis A/B/C and HIV were negative. Upper GI-EUS with FNA of the tumorous and partly cystic pancreatic head yielded necrotic material with few lymphocytes. Abdominal ultrasound (AUS) revealed hypoechoic masses of the pancreatic head and peripancreatic lymphomas without signs of local thrombosis. Histologic specimen gained by ultrasound-guided FNA showed necroses and granulomas. The initial (EUS-FNA) microbiologic probes were negative for AFB, but TB-specific PCR and cultures (AUS-FNA) were positive. After initiation of tuberculostatic therapy, the patient was afebrile within 24 h. Abnormal laboratory parameters gradually normalised. In the short-term follow-up, the pancreatic mass substantially decreased in size. Pancreatic tuberculosis is a rare differential diagnosis of pancreatic carcinoma, which may be curable just by tuberculostatic treatment.