Diagnostic approaches for pancreatic tuberculosis

Changxin, Wu; Xiao, Libing; Luo, Zhong-Fei; Shi, Shaohua

doi:10.1016/j.hbpd.2022.01.004

Cited by 3 publications

(5 citation statements)

References 10 publications

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“… 11 , 12 Recent findings suggest that EUS-FNA is very important in the treatment process of pancreatic solid space-occupying lesions without pulmonary tuberculosis. 13 If the results of EUS-FNA indicate a granuloma, but there is no caseous necrosis and negative acid fast staining, then PPD, ESR and T-SPOT tests should be undertaken. 13 If these tests are positive, tuberculosis should be considered clinically and further tuberculosis tests should be conducted.…”

Section: Discussionmentioning

confidence: 99%

“… 13 If the results of EUS-FNA indicate a granuloma, but there is no caseous necrosis and negative acid fast staining, then PPD, ESR and T-SPOT tests should be undertaken. 13 If these tests are positive, tuberculosis should be considered clinically and further tuberculosis tests should be conducted. 13 This current case also confirms this approach.…”

Section: Discussionmentioning

confidence: 99%

“… 13 If these tests are positive, tuberculosis should be considered clinically and further tuberculosis tests should be conducted. 13 This current case also confirms this approach. Various non-typical symptoms are observed in abdominal tubercular infections, but this current case only presented with upper abdominal pain and nausea.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis of retroperitoneal tuberculosis: A case report

Liu

Xiao

et al. 2023

J Int Med Res

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Retroperitoneal tuberculosis is a rare disease that can mimic many conditions and lacks specific clinical manifestations, which makes it difficult to diagnose. As a consequence, it can be misdiagnosed as a malignant tumour. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) can obtain specimens of the lesion site from areas that might be inaccessible using more traditional biopsy methods. A 60-year-old female patient was admitted with a 3-month history of intermittent upper abdominal pain accompanied by nausea. Imaging found pancreatic uncinate process and retroperitoneal lymph nodes at the horizontal part of the duodenum. EUS-FNA found necrotic matter, multinucleated giant cells and epithelioid cells consistent with the signs of tuberculosis bacilli infection, although typical noncaseous granuloma and Mycobacterium tuberculosis were not observed. Retroperitoneal tuberculosis was considered as the diagnosis. After anti-tubercular therapy, the signs and symptoms quickly improved and a repeat computed tomography scan found that the space-occupying lesion had reduced in size. By using EUS-FNA, the cytological and histopathological findings can be obtained in a timely manner to facilitate an earlier diagnosis and avoid unnecessary procedures such as laparotomy or surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis of retroperitoneal tuberculosis: A case report

Liu

Xiao

et al. 2023

J Int Med Res

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“…EUS-FNB allows obtaining pancreatic specimens with cytopathology. Many cases have been published worldwide in the last few years with different and non-specific clinical manifestations (Table 1 )[ 5 , 7 - 10 ].…”

Section: Pancreatic Tbmentioning

confidence: 99%

“…In the presence of a pancreatic abscess, percutaneous or EUS-aspiration should be performed to make the correct diagnosis and avoid unnecessary surgery. Some patients, even under ATT, can develop pruritus with cholestatic symptoms or severe cholangitis, and a biliary stent will be placed[ 10 ].…”

Section: Treatmentmentioning

confidence: 99%

Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy: Don't miss the tuberculosis

Delsa¹,

Bellahammou²,

Okasha³

et al. 2023

World J Clin Cases

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Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis. Recently, macroscopic on-site evaluation (MOSE) performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB. The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB. Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms. Therefore, this challenging diagnosis is based on endoscopy, imaging, and the bacteriological and histological examination of tissue biopsies. This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer. EUS-FNB can be very useful in providing a valuable histopathological diagnosis. A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis, leading to the request of the GeneXpert, which can detect Mycobacterium tuberculosis deoxyribonucleic acid and resistance to rifampicin. A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.

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Pancreatic Tuberculosis: Arterial Infusion of Isoniazid as an Adjunct to Oral Antituberculosis Medications Has Demonstrated Promising Therapeutic Efficacy

Li,

He,

Ding

et al. 2024

Preprint

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Background Isolated pancreatic tuberculosis is a rare manifestation of Mycobacterium tuberculosis infection in the human body, presenting substantial challenges in clinical diagnosis and treatment. This report details a case characterized by a space-occupying lesion in the pancreas. CASE presentation A 35-year-old male presented at our medical center with upper abdominal distension and pain. Pre- and post-admission Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans revealed a pronounced ring-enhanced mass at the head of the pancreas, compressing the adjacent common bile duct. Additional findings included multiple enlarged lymph nodes near the lesion. Initially, the imaging department suggested a pancreatic neuroendocrine tumor. Despite no known tuberculosis exposure and negative laboratory and DNA tests for tuberculosis bacilli, except for a positive tuberculin skin test, the lesion was ultimately identified as a pancreatic tuberculous granuloma through endoscopic ultrasound-guided fine needle aspiration. Given the granuloma's rich arterial blood supply, we performed pancreaticoduodenal artery angiography and locally infused anti-tuberculosis drugs to reduce the patient's abdominal pain. The patient then began standard oral anti-tuberculosis therapy. Follow-up evaluations at 4 and 7 months showed continuous reduction in the size of the lesion, relieving pressure on nearby structures and causing no discomfort to the patient. Conclusions When imaging and laboratory tests cannot distinguish isolated pancreatic tuberculosis lesions from pancreatic cystic tumors, endoscopic ultrasound-guided fine needle aspiration should be considered. Local arterial infusion of isoniazid, while monitoring for hepatotoxicity, has proven highly effective in promptly reducing clinical symptoms in patients. Combined with conventional oral antituberculosis drug therapy, the long-term prognosis for patients appears favorable.

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Diagnostic approaches for pancreatic tuberculosis

Cited by 3 publications

References 10 publications

Endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis of retroperitoneal tuberculosis: A case report

Endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis of retroperitoneal tuberculosis: A case report

Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy: Don't miss the tuberculosis

Pancreatic Tuberculosis: Arterial Infusion of Isoniazid as an Adjunct to Oral Antituberculosis Medications Has Demonstrated Promising Therapeutic Efficacy

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