Imposter Posing a Diagnostic Difficulty—Great Masquerader of Pancreatic Tuberculosis

Background: Pancreatic tuberculosis is a rare clinical entity. It represents a diagnostic challenge as it can be easily confused with malignancy or pancreatitis on imaging. This could result in unnecessary surgery. As this is a treatable disease, it is imperative to diagnose this condition preoperatively.

Case Presentation: A 50-year-old gentleman k/c/o hypertension and hypothyroidism recently diagnosed case of acute myeloid leukemia came with complains of fever since 1 month and was admitted for further evaluation. Routine blood investigations which were suggestive of febrile neutropenia and managed conservatively with IV antibiotics. Patient was having persistent fever spikes and was evaluated further with serum and BAL galactomannan assays which were positive. USG abdomen done showed bulky pancreas and heterogenous echotexture. Patient was deteriorating despite starting antifungals and a CECT abdomen done showed a lobulated enhancing mass in tail of the pancreas differentials being leukemic deposit versus primary pancreatic malignancy. CA 19-9 levels done were normal. Patient was taken up for EUS (endoscopic ultrasound)-guided FNAC which showed a hypoechoic mass measuring 2 × 3 cm in the tail of the pancreas. FNAC was consistent with granulomatous inflammation with GeneXpert being positive showing Mycobacterium tuberculosis. Anti-tuberculous therapy was started, showed complete resolution of symptoms and radiological abnormalities.

Conclusion: Tuberculosis is a major health problem worldwide. The clinical features of pancreatic TB are protean and include weight loss, fever, and night sweats. EUS has emerged as an important tool for imaging and sampling pancreatic lesion. This case highlights the rarity of pancreatic TB. It emphasizes the need for preoperative diagnosis of this treatable condition. EUS can play a pivotal role in securing diagnosis of pancreatic TB. The high resolution images enable malignancy to be excluded, whilst there are morphological features that favor a diagnosis of TB. EUS-FNA should be performed and samples submitted for cytology, AFB cultures, and PCR assay to maximize the diagnostic yield.

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Artikel online veröffentlicht:
22. April 2024