Pancreatic Tuberculosis Presenting With Vague Abdominal Pain and Pancreatic Mass Diagnosed Non-invasively With EUS-Guided FNA

Abstract

Pancreatic mass may be diagnosed as abscess, pancreatitis, or pancreatic cancer. Rarely is tuberculosis a primary consideration. Patients are often misdiagnosed as malignancy and are subjected to unnecessary surgeries, only to find that the mass is tuberculous in origin. Isolated primary pancreatic TB is extremely rare. We report a 60-year-old Filipino female who complained of 1 month non-specific epigastric pain. Physical examination was essentially normal. Ultrasound of the whole abdomen and CT scan revealed a 3.6 x 2.9 x 3.2 cm pancreatic mass at the junction of the neck and body of pancreas. CA19-9 was normal. Endoscopic ultrasound with fine needle aspiration was done on the hypoechoic mass lesion at the head to the neck region measuring 3.54 x 2.71 cm. Cytomorphologic findings consistent with chronic granulomatous inflammation were seen. Patient was started on quadruple anti-Koch’s therapy (Isoniazid, Rifampizin, Ethambutol, and Pyrazinamide). A repeat EUS and ultrasound done after 3 months showed interval disappearance of the mass lesion. Pancreatic tuberculosis should be included in the differential diagnosis of a pancreatic mass in areas endemic for tuberculosis.