Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China

Xia, Feng; Poon, Ronnie Tung‐Ping; Wang, Shuguang; Bie, Ping; Huang, Xuequan; Dong, Jiahong

doi:10.3748/wjg.v9.i6.1361

Cited by 110 publications

(135 citation statements)

References 18 publications

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“…Other potential diagnostic methods include obtaining tissue specimens by laparoscopy [17] or endoscopic ultrasound with FNA [27] . Though in practice, the diagnosis is often established at operation [6,7,18,26] or even after surgery by histology [4] or PCR-based assay [2,4,6,8,10] , as was the case in our patient.…”

Section: Discussionmentioning

confidence: 88%

“…Four mechanisms have been described: TB of the pancreas itself may cause pseudoneoplastic obstructive jaundice [1][2][3][4][5][6][7][8][9][10] ; it may be secondary to TB lymphadenitis causing compression and inflammation of the lymph nodes and the CBD [6,[11][12][13][14][15][16][17][18][19] , as in our case, with caseation of the lymph node causing fistulation into the CBD; biliary TB itself may lead to single or multiple strictures, mimicking cholangiocarcinoma [20][21][22][23][24][25] ; and TB can create a retroperitoneal mass leading to biliary tree obstruction [26] .…”

Section: Discussionmentioning

confidence: 99%

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Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Colović¹,

Grubor²,

Jesic³

et al. 2008

WJG

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Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum.A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed t u b e rc u l o u s l y m p h a d e n i t i s . A f t e r a n u n e ve n t fu l postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Colović¹,

Grubor²,

Jesic³

et al. 2008

WJG

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“…Pancreatic tuberculosis may present with a wide variety of manifestations, including fever, abdominal pain, anorexia, weight loss, obstructive jaundice, acute or chronic pancreatitis and gastrointestinal hemorrhage [3][4][5][6][9][10][11]. The nonspecific symptomatology and lack of clinical findings therefore, make the clinical diagnosis of pancreatic tuberculosis practically impossible.…”

Section: Discussionmentioning

confidence: 99%

“…Since the clinical and radiographic presentations are nonspecific and often mimic pancreatic cancer, preoperative diagnosis is rare [14][15][16]. Laboratory findings are also nonspecific for tuberculosis involving the pancreas, thus, the diagnosis of pancreatic tuberculosis is usually based on histopathologic and microbiologic testing [3][4][5][6]9]. However, it must be remembered that bacteriologic confirmation may not be possible in many patients.…”

Section: Discussionmentioning

confidence: 99%

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Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Acar¹,

Sücüllü²,

Baylan³

et al. 2010

Open Medicine

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AbstractIsolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient’s occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient’s initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards.

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Extra Pulmonary Lymph Node, Abdominal and Pericardial Tuberculosis

Dedicoat

2021

Tuberculosis in Clinical Practice

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Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China

Cited by 110 publications

References 18 publications

Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Extra Pulmonary Lymph Node, Abdominal and Pericardial Tuberculosis

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