Pancreatic Tuberculosis: A Rare Diagnosis by Endoscopic Ultrasound Guided Fnac

Abstract

Introducation: Tuberculosis remains a threat to global public health and is the top infectious cause of death globally. The burden of extrapulmonary tuberculosis (EPTB) is high, ranging from 15-20% of all TB cases in HIV negative patients while in HIV positive people, it account for 40-50% of new TB cases. Abdominal TB cases makes up about 3 % of all EPTB cases in India. In abdominal tuberculosis, Ileocaecal region is most commonly affected; solid organs like kidney, spleen and liver get involved with Tuberculosis much more commonly than the pancreas. Pancreatic tuberculosis is very rare even in regions with high prevalence of tuberculosis. Pancreatic tuberculosis most commonly aficts the region of the head and the uncinate process of the pancreas. It is often misdiagnosed due to low index of suspicion and masquerading of its symptoms as pancreatic malignancy. Case Presentation: A 67 years old male presented to the physician with a history of pain abdomen in umbilical region. Ultrasound whole abdomen demonstrated mildly bulky pancreas with ill dened hypoechoic lesion in the body region. Endoscopic ultrasound-guided ne needle aspiration (EUS-FNA) of the lesion was performed and cytology revealed numerous acid fast bacilli with necrotic material in background of red blood cells. Abdominal computed tomography (CT) scan was done which was suggestive of well- dened non enhancing multiloculated lesions of body of pancreas with evidence of necrotic lymph node in pre and left para-aortic region. Antitubercular treatment was started accordingly. Conclusion: Pancreatic tubercuklosis may present as pancreatic abscess, pancreatitis,or acystic or solid pancreatic mass. The use of EUS-FNA has become essential tool in the evaluation of pancreatic lesion.