Pancreatic Tuberculosis in a Patient with HIV

Abstract

Purpose: Pancreatic and peripancreatic tuberculosis is extremely rare even in countries with high endemism. Fewer than 40 cases of pancreatic tuberculosis have been reported worldwide. There is a recent increase in such cases, but the infrequency with which it is encountered makes it a formidable diagnostic challenge. Methods: We report a 47 year old Ethiopian immigrant male with HIV presented with fever, abdominal pain and weight loss. He appeared weak and diaphoretic but was awake and oriented. His vital signs were stable, except for temperature of 103.0F. His physical exam was unremarkable, except for mild abdominal tenderness and splenomegaly. Results: CT scan abdomen showed a complex cystic mass in the pancreatic head with internal septations, associated with extensive retroperitoneal adenopathy. Necrotic pancreatitis and pseudocyst were considered much less likely given the apparent septations and associated adenopathy. A CT guided biopsy of multiple periaortic lymph nodes was positive for mycobacterium tuberculosis complex by smear and culture. He was started on 4 drug antitubercular therapy, resulting in resolution of the pancreatic mass after 9 months (see images). Conclusion: Although rare, pancreatic and peripancreatic tuberculosis should be considered in the differential diagnosis of cystic lesions of the pancreas. On review of literature, the key to diagnosis of pancreatic tuberculosis is CT guided needle biopsy of the involved tissue and these masses respond well to antitubercular therapy.TableTable: Laboratory Investigations in our PatientFigure: CT abdomen showing the complex cystic pancreatic mass.Figure: CT abdomen showing resolution of the cystic pancreatic mass after nine months of antitubercular therapy.