Isolated pancreatic tuberculosis masquerading as malignancy in an immunocompetent host: a case report and review of the literature

Gu, Yangjun; Xiao, Min; Wan, Zhenmiao; Li, Qiyong

doi:10.1177/03000605231189134

Cited by 2 publications

(2 citation statements)

References 31 publications

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“…TB has resurfaced as a significant concern over the past two decades, largely attributed to the increasing prevalence of immunodeficiency and immunosuppression. Factors such as globalization, evolutionary changes in bacterial biology, and the development of drug resistance have further contributed to its resurgence [ 1 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

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An Unusual Cause of Pancreatic Tumor

Sabri,

Ahmed,

Rakhange

2024

Cureus

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Pancreatic tuberculosis (TB) is a rare condition that can be challenging to distinguish from other pancreatic neoplasms. We present the case of a 48-year-old Indian male who complained of persistent vague epigastric pain for two months. Other physicians saw him and treated him like a dyspeptic case. He gave a history of daily alcohol consumption. Routine investigations, including amylase and lipase levels, were within normal limits. However, an abdominal ultrasound revealed a cystic lesion in the body of the pancreas, prompting further investigation. A subsequent abdominal CT scan revealed a tumor of 6x4 cm in diameter with solid and cystic components in the pancreatic body. Although tumor markers were not remarkable, inflammatory markers showed elevated levels of ESR (erythrocyte sedimentation rate) of 95 mm/hr and CRP (C-reactive protein) of 83 mg/L, with normal hemoglobin. Endosonography (EUS) with fine needle aspiration (FNA) was performed to achieve a definitive diagnosis. EUS was performed with a linear echoendoscope, which revealed the mass, which had solid and cystic components. Fluid was aspirated from the cystic part and FNA passes were performed in the solid part. Microscopic examination and aspirated fluid culture confirmed the presence of Mycobacterium tuberculosis , while the solid part revealed caseation-indicated granulomas, indicative of TB. The patient was promptly initiated on a seven-month course of three anti-TB medications, leading to normalization of ESR and CRP levels during the treatment period. A follow-up abdominal CT scan showed complete resolution of the pancreatic lesion, indicating successful management. This case is rare and all the data in the literature is mainly in the form of case reports. Using EUS with FNA has transformed the diagnosis of pancreatic malignancy into a curable disease that could be easily managed with anti-TB medications.

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Section: Discussionmentioning

confidence: 99%

“…Tuberculosis (TB), caused by Mycobacterium tuberculosis , continues to be the leading infectious disease, responsible for nearly 4,000 deaths per day worldwide. Although most TB cases are pulmonary, about 20% are extrapulmonary, with abdominal TB accounting for 10% of cases [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

An Unusual Cause of Pancreatic Tumor

Sabri,

Ahmed,

Rakhange

2024

Cureus

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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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Isolated pancreatic tuberculosis masquerading as malignancy in an immunocompetent host: a case report and review of the literature

Cited by 2 publications

References 31 publications

An Unusual Cause of Pancreatic Tumor

An Unusual Cause of Pancreatic Tumor

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

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