Pancreatic and Peripancreatic Nodal Tuberculosis in Immunocompetent Patients: Report of Three Cases

Sukanta Ray; Kshaunish Das; Asit Ranjan Mridha

doi:10.6092/1590-8577/1108

Sukanta Ray Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research. Kolkata, West Bengal, India
Kshaunish Das Division of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research. Kolkata, West Bengal, India
Asit Ranjan Mridha Division of GI Pathology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research. Kolkata, West Bengal, India

DOI: https://doi.org/10.6092/1590-8577/1108

Keywords: Biopsy, Fine-Needle, Lymph Nodes, Pancreas, Tuberculosis

Abstract

Context Pancreatic and peripancreatic tuberculosis in immunocompetent patients is extremely rare. It often mimics pancreatic malignancy. Majority of the cases are diagnosed after an image guided biopsy or after an operation. Case report We report three cases of pancreatic tuberculosis in immunocompetent patients. All three cases were diagnosed without laparotomy. Diagnosis was made by contrast enhanced computed tomography or endoscopic ultrasound guided fine needle aspiration of the peripancreatic mass and all three cases were treated successfully with antituberculous drugs. Conclusion Pancreatic and peripancreatic tuberculosis should be considered in the differential diagnosis of a peripancreatic mass when the patient is young, residing in the endemic zone of tuberculosis or had past history of tuberculosis. Extensive necrosis of peripancreatic lymph nodes with rim enhancement further supports the diagnosis of tuberculosis. Every attempt should be made to diagnose the cases before start of therapy to prevent unnecessary operation.

Image: Ziehl-Neelsen stain showing acid fast bacilli.

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