Primary Pancreatic Tuberculosis Mimicking Pancreatic Body Cancer

Introduction: Tuberculosis is a condition caused by Mycobacterium tuberculosis, that most commonly affects the lungs. Pancreatic localization is very rare and is mostly encountered in patients with immunosuppressive disorders. The diagnosis is often challenging as clinical and radiological features can mimic pancreatic cancer

Case: A 52-year-old woman has history of loose stools and pain abdomen for 10 days and loss of appetite since 2 months for which he got evaluated in outside hospital, where CECT abdomen was done it showed: two hypoechoic lesions in the head of the pancreas with peripancreatic, precaval and periportal lymph nodes could be suggestive of neoplastic etiology. Patient got evaluated by oncologist, tumor markers such as CA 19-9 and CEA showed normal levels, latter patient visited gastroenterology department, and was planned for EUS, it showed periportal multiple irregular lymph nodes with an irregular cystic area in the neck-body of pancreas with areas of necrosis adjacent to it. EUS-guided FNAC done and sample sent for AFB, Gram stain, culture, and genexpert mycobacterium. Genexpert mycobacterium showed Mtb positive. Patient was started on ATT according to weight basis regimen

Discussion: The pancreas is relatively resistant to TB because the pathogen is destroyed by pancreatic enzymes. However, once TB breaks through this line of defense, it may cause pancreatic TB. Most of the cases are secondary to contagious infection from peripancreatic lymph nodes or rarely from hematogenous spread. Direct histopathological examination is the best way of diagnosing TB. Pancreatic TB is difficult to diagnose, but once diagnosed, it responds well with conventional ATT.

Conclusion: Pancreatic TB is usually difficult to diagnose, requiring a high index of clinical suspicion. TB should always be considered in the differential diagnosis of any pancreatic masses as it usually responds well to ATT.

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Publication History

Article published online:
22 April 2024