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

Abstract

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.