Pancreatic Mass: Include Tuberculosis in the Differential Diagnosis

Darpan Sohni

doi:10.7759/cureus.15430

Abstract

Although abdominal tuberculosis (TB) is quite prevalent in endemic regions, involvement of the pancreas is considerably rare. We describe a case of pancreatic TB presenting as a pancreatic mass in a patient with abdominal pain and jaundice. Due to the similar presentation, it can easily be misinterpreted as a pancreatic neoplasm. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can help confirm the diagnosis in such cases by providing histopathological evidence of Mycobacterium tuberculosis infection. The patient made a remarkable recovery post anti-tuberculous therapy (ATT) initiation. This exceptional response of pancreatic TB to conservative management makes it imperative that the condition be diagnosed promptly to avoid any futile surgical interventions and associated complications. This can only be achieved if clinicians are aware of the diagnostic possibility of pancreatic TB presenting as a mass in the pancreas.

Highlights

Tuberculosis (TB) of the pancreas is a remarkably unusual clinical entity; all the more so in immunocompetent individuals
We describe a case of isolated pancreatic TB presenting as a discrete mass in the pancreas in an immunocompetent host
Pancreatic TB usually presents with nonspecific symptoms such as abdominal pain, jaundice, vomiting, anorexia, or weight loss [3]

Summary

Introduction

Tuberculosis (TB) of the pancreas is a remarkably unusual clinical entity; all the more so in immunocompetent individuals. We describe a case of isolated pancreatic TB presenting as a discrete mass in the pancreas in an immunocompetent host. The pain was progressive, non-radiating, and predominantly in the epigastric region. He complained of nausea for two days and one episode of vomiting. The patient had a history of admission for acute pancreatitis four years prior for which he was treated conservatively. Clinical examination showed a thin and lean individual in mild distress. Abdominal examination revealed moderate tenderness in the epigastric and umbilical regions. The patient was started on anti-tuberculous therapy (ATT) with first-line agents. The patient regained his appetite and weight and was doing well six months post-treatment. A follow-up CT taken almost seven months after treatment initiation showed resolution of the pancreatic lesion

Discussion

Conclusions

Disclosures