Pancreatic Tuberculosis—A Condition That Mimics Pancreatic Cancer

Abstract

Tuberculosis is a disease with serious consequences in terms of morbidity and mortality. Pancreatic localization is very rare and is mostly encountered in patients with immunosuppressive disorders. A 59-year-old woman with arterial hypertension, grade 2 obesity, and a history of cholecystectomy, was admitted for fever (38.5 °C), jaundice, and marked physical asthenia. The blood tests showed severe metabolic acidosis, with partial respiratory compensation, mild microcytic normochromic anemia, inflammatory syndrome, procalcitonin value ten times the upper limit of normal, nitrogen retention syndrome, hypoalbuminemia, hypertriglyceridemia, hypercholesterolemia, and moderate hyponatremia. The electrocardiogram, chest X-ray, and abdominal ultrasound did not show any significant pathological changes. Contrast-enhanced computed tomography raised the suspicion of acute-on-chronic pancreatitis and subsequent evaluation by magnetic resonance imaging raised the suspicion of a pancreatic tumor. Pancreatic fine needle biopsy under echoendoscopic guidance revealed purulent material, which was sent for cytological and bacteriological examination. The Ziehl-Neelsen stain showed acid-alcoholic resistant bacilli, while bacterial cultures were positive for gentamicin and tigecycline-sensitive Klebsiella. The diagnosis of pancreatic tuberculosis was established. Pancreatic tuberculosis is a very rare condition that often mimics pancreatic cancer. The peculiarity of the case is the appearance of pancreatic tuberculosis in an immunocompetent woman and the association with Klebsiella infection.

Distribution analysis of positive and negative pathogenic bacteria in patients with acute pancreatitis and the clinical characteristics and model prediction analysis of positive infection bacteria

“…At this stage, antibiotic intervention can prevent the deterioration of the disease but it cannot prevent the occurrence of infection. Thus, determining methods of identifying pathogenic bacteria in the early stage of the disease is very important ( 12 ). The discharge of pancreatic juice and bile has a similar anatomical structure.…”

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

“…9,10 Many cases of pancreatic tuberculosis are confirmed by postoperative pathological examination. 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.…”

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

“…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 ].…”

“…However, no studies described the sample's aspect based on the final diagnosis. Diaconu reported a case of pancreatic TB with a cephalic pancreatic lesion and changes suggesting chronic pancreatitis; the EUS-FNB revealed purulent material with a positive culture for TB[ 5 ]. Therefore, when the EUS-FNA/FNB shows purulent material, a cytological and bacteriological examination must be performed to exclude pancreatic TB.…”

“…Pancreatic TB remains a rare site of abdominal TB, often misdiagnosed as pancreatic carcinoma. Nevertheless, endoscopic ultrasound (EUS) with pancreatic fine needle aspiration or biopsy (FNA/FNB) and a polymerase chain reaction (PCR) are important tools to make the definitive diagnosis and to initiate adequate treatment[ 4 , 5 ].…”