A 57-year-old female patient presented with complaints of abdominal pain and persistent vomiting for one month. The abdominal pain was predominantly in the epigastrium, non-radiating and associated with post prandial vomiting. The pain was relieved after the bout of vomiting. The patient had occasional febrile episodes and loss of appetite. The patient was a known case Chronic Calcific Pancreatitis and Diabetes Mellitus with both exocrine and endocrine deficiency. She was on pancreatic supplements and human insulin for the past 5 years. On examination, mild epigastric tenderness was present.Blood picture showed normochromic normocytic cells. Prothrombin Time (PT), Liver Function Tests (LFT), Thyroid Function Tests (TFT), serum calcium and Parathormone levels were normal. Serum amylase and lipase were within normal range. Cancer Antigen 19-9 (CA 19-19) was not elevated. Random Blood Sugar and Glycated Haemoglobin (HbA1c) were high. Urine showed glycosuria but urinary ketones were negative. Blood and Urine cultures were sterile.Chest X-Ray was normal. Ultrasound abdomen showed chronic calcific pancreatitis with dilated Main Pancreatic Duct (MPD) and tiny intraductal calculi. Common Bile Duct (CBD) was dilated with dilated Inta Hepatic Biliary Radicles. Upper GI endoscopy showed reflux esophagitis with bile reflux. CECT of abdomen showed calcifications in pancreatic head, body and tail with atrophic parenchyma, dilated MPD and multiple intraductal calculi [Table/ Fig-1]. A mass was suspected to be present inferiomedial to the head of the pancreas. Intestinal obstruction was confirmed as Barium meal and follow through showed narrowing in the second part of duodenum. Endoscopy showed pus oozing out from the second part of the duodenum [Table /Fig-2]. Biopsy from the periampullary region of the duodenum showed that there was chronic nonspecific duodenitis with no evidence of invasive malignancy. EUS guided FNAC was done and revealed that the head of pancreas had features of chronic pancreatitis with a few acid fast bacilli. This enabled to arrive at the diagnosis of Tuberculosis of the pancreas.She was started on ATT and Naso Jejeunal (NJ) feeds. She was given Streptomycin, Ethambutol, Isoniazid, Pyrizinamide and Rifampicin in compliance with standardized treatment regimes. She tolerated the treatment well. Repeat LFTs were done and were normal. Her condition progressively improved and she was started on oral feeds. Keywords: Anti tuberculosis therapy, Endoscopic ultrasound, Pancreas ABSTRACTPancreatic Tuberculosis is an uncommon form of extra pulmonary tuberculosis that resembles malignancy of pancreas and serve as a diagnostic challenge for physicians. Conservative management with Anti Tuberculosis Therapy (ATT) will suffice for pancreatic tuberculosis whereas a malignancy may require major surgeries which may lead to significant morbidity. Here, we discuss the case of a female patient who presented with abdominal pain and vomiting and is a known case of chronic calcific pancreatitis. Radiological findings were tha...
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