Pancreatic Tuberculosis: An Overview
Abstract
Pancreatic tuberculosis is a rare occurrence in either immune-competent or immune-suppressed host. Pancreatic tuberculosis most commonly afflicts the region of the head and the uncinate process of the pancreas. It is often misdiagnosed due to low index of suspicion and masquerading of its symptoms as more common pancreatic conditions such as pancreatic malignancy. However, Endoscopic ultrasound fine needle aspiration sampling with an acid-fast smear is essential for establishing the diagnosis of pancreatic tuberculosis. If the diagnosis is delayed, pancreatic tuberculosis can be fatal. Pancreatic tuberculosis responds well to standard anti-tuberculous drugs.
Image: Taleghani Hospital. Tehran, Iran.
Downloads
References
Cherian JV, Somasundaram A, Ponnusamy RP, Venkataraman J. Peripancreatic tuberculous lymphadenopathy. An impostor posing diagnostic difficulty. JOP 2007; 8:326-329. [PMID: 17495362]
Ahlawat SK, Charabaty-Pishvaian A, Lewis JH, et al. Pancreatic tuberculosis diagnosed with endoscopic ultrasound guided fine needle aspiration. JOP 2005; 6:598-602. [PMID: 16286712]
Floyd K1, Pantoja A. Financial resources required for tuberculosis control to achieve global targets set for 2015. Bull World Health Organ. 2008; 86:568-76. [PMID: 18670669]
Kaushik N, Schoedel K, McGrath K. Isolated pancreatic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report. JOP 2006; 7:205-10. [PMID: 16525205]
1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992; 41(RR-17):1-19. [ http://goo.gl/aVcOKw]
D'Cruz S, Sachdev A, Kaur L, Handa U, Bhalla A, Lehl SS. Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: a case report and review of literature. JOP 2003; 4:158-62. [PMID: 12853684]
Schneider A, Birgelen CV, Dührsen U, Gerken G, Rünzi M. Two cases of pancreatic tuberculosis in non-immunocompromised patients: a diagnostic challenge and a rare cause of portal hypertension. Pancreatology 2002; 2:69-73. [PMID: 12120010]
Mellick SA. Sir Kenelm Digby (1603–1665): diplomat, entrepreneur, privateer, duellist, scientist and philosopher. ANZ J Surg 2011; 81: 911–4. [PMID: 22507419]
Le Claire L. Kenelm Digby – ‘The Mirandola of his age’. The Wilkinson Lecture 2005. Worcester College Record 2005: 51–69. [http://goo.gl/hT0q5Q]
Sachdev A, D’Cruz S, Chauhan S, Thakur R, Kapoor V, Handa U. Pancreaticobiliary tuberculosis diagnosed by endoscopic brushings. JOP 2006; 7: 665-669. [PMID: 17095849]
Echenique Elizondo M, Amondarain Arratíbel J, Compton CC, Warshaw AL. Tuberculosis of the pancreas. Surgery 2001; 129:114-6. [PMID: 11150042]
Pramesh CS, Heroor AA, Gupta SG, Krishnamurthy S, Shukla PJ, Jagannath P, et al. Pancreatic tuberculosis: an elusive diagnosis. HPB (Oxford) 2003; 5:43-5. PMID: 18332958]
Khan R, Abid S, Jafri W, et al. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol 2006; 12:6371-5. [PMID: 17072964]
Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol 1977; 67:324-37. [PMID: 879148]
Yokoyama T, Miyagawa S, Noike T, et al. Isolated pancreatic tuberculosis. Hepatogastroenterology 1999; 46:2011-4.[ PMID: 10430386]
Puri R, Thandassery RB, Eloubeidi MA, Sud R. Diagnosis of isolated pancreatic tuberculosis: the role of EUS-guided FNA cytology. Gastrointest Endosc. 2012; 75:900-4.[ PMID: 22440205]
Chen CH, Yang CC, Yeh YH, Yang JC, Chou DA. Pancreatic tuberculosis with obstructive jaundice--a case report. Am J Gastroenterol 1999; 94:2534-2536. [PMID: 10484020]
Tosun S, Tosun A. Imaging of malignancy-suspected pancreatic involvement of extrapulmonary tuberculosis. Turk J Gastroenterol 2010; 21:54-9. [ PMID: 20533115]
Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004; 120: 316-353. [PMID: 15520485]
Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004; 120: 305-315. [PMID: 15520484]
Turan M, Sen M, Koyuncu A, et al. Pancreatic pseudotumor due to peripancreatic tuberculous lymphadenitis. Pancreatology 2002; 2:561-4. [PMID: 12435870]
Evans JD, Hamanaka Y, Olliff SP, Neoptolemos JP. Tuberculosis of the pancreas presenting as metastatic pancreatic carcinoma. A case report and review of the literature. Dig Surg 2000; 17:183-7. [ PMID: 10781988]
Turan M, Sen M, Koyuncu A, Aydin C, Elaldi N, Arici S. Pancreatic pseudotumor due to peripancreatic tuberculous lymphadenitis. Pancreatology 2002; 2:561-4. [PMID: 12435870]
Khaniya S, Koirala R, Shakya VC, Adhikary S, Regmi R, Pandey SR, et al. Isolated pancreatic tuberculosis mimicking as carcinoma: a case report and review of the literature. Cases J 2010; 3:18. [PMID: 20205859]
Tan KK, Chen K, Liau KH, Ho CK. Pancreatic tuberculosis mimicking pancreatic carcinoma: Series of three cases. Eur J Gastroenterol Hepatol 2009; 21:1317-9. [PMID: 19474749]
Pereira JM, Madureira AJ, Vieira A, Ramos I. Abdominal tuberculosis: imaging features. Eur J Radiol 2005; 55:173–80. [PMID: 2653722]
Meinke AK. Pancreatic tuberculous abscess. Conn Med 1989; 53: 139-141. [PMID: 2653722]
Auerbach O. Acute Generalized Miliary Tuberculosis. Am J Pathol 1944; 20:121-136. [PMID: 19970738]
Fee MJ, Oo MM, Gabayan AE, Radin DR, Barnes PF. Abdominal tuberculosis in patients infected with the human immunodeficiency virus. Clin Infect Dis 1995; 20: 938-944. [PMID: 7795098]
Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB. Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA 1986; 256:362–6. [PMID: 3723722]
Xia F, Poon RT, Wang SG, Bie P, Huang XQ, Dong JH. Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China. World J Gastroenterol 2003; 9:1361-4. [PMID: 12800257]
Meesiri S. Pancreatic tuberculosis with acquired immunodeficiency syndrome: a case report and systematic review. World J Gastroenterol 2012; 18:720-726. [PMID: 22363146]
Maniar JK, Kamath RR, Mandalia S, Shah K, Maniar A. HIV and tuberculosis: partners in crime. Indian J Dermatol Venereol Leprol 2006; 72: 276-282. [PMID: 16880573]
Woodfield JC, Windsor JA, Godfrey CC, et al. Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review. ANZ J Surg 2004; 74:368–371. [PMID: 15144259]
Paraf A, Ménager C, Texier J. Tuberculosis of the pancreas and tuberculosis of the lymph nodes of the upper region of the abdomen. Rev Med Chir Mal Foie 1966; 41:101–126. [PMID: 5944700]
Mansoor J, Umair B. Primary pancreatic tuberculosis: a rare and elusive diagnosis. J Coll Physicians Surg Pak. 2013; 23:226-8. [PMID: 23458052]
Brugge WR, Mueller PR, Misdraji J Case 8-2004 N Engl J Med 2004 350: 1131-1138. [PMID: 15014187]
Knowles KF, Saltman D, Robson HG, Lalonde R. Tuberculous pancreatitis. Tubercle 1990; 71:65-68. [PMID: 2371763]
Nagar AM, Raut AA, Morani AC, Sanghvi DA, Desai CS, Thapar VB. Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr 2009; 33: 136-141. [PMID: 19188801]
Echenique Elizondo M, Amondarain Arratibel JA, Iribarren Loyarte J. Pancreatic tuberculosis: the rebirth of a timeworn problem. Cir Esp 2000; 67:103-105. http://goo.gl/dDQRcm
Vafa H, Arvanitakis M, Matos C, et al. Pancreatic tuberculosis diagnosed by EUS: one disease, many faces. JOP 2013; 14:256-260. [PMID: 23669474]
D’Cruz S, Sachdev A, Kaur L, Handa U, Bhalla A, Lehl SS. Fine needle aspiration diagnosis of isolated pancreatic tuberculosis. A case report and review of literature. JOP 2003; 4:158-162. [PMID: 12853684]
Weiss ES, Klein WM, Yeo CJ. Peripancreatic tuberculosis mimicking pancreatic neoplasia. J Gastrointest Surg 2005; 9:254-62. [PMID: 15694822]
Chaudhary A, Negi SS, Sachdev AK, Gondal R. Pancreatic tuberculosis: still a histopathological diagnosis. Dig Surg 2002; 19:389-392. [PMID: 12435910]
Ezratty A, Gumaste V, Rose E, Sachar DB, Tiscornia-Wasserman P. Pancreatic tuberculosis: a frequently fatal but potentially curable disease. J Clin Gastroenterol 1990; 12:74-77. [PMID: 2105992]
Sonthalia N, Ray S, Pal P, Saha A, Talukdar A. Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: A case report. World J Clin Cases 2013 16; 1:181-6.[PMID: 24303497]
Crowson MC, Perry M, Burden E. Tuberculosis of the pancreas: a rare cause of obstructive jaundice. Br J Surg 1984; 71:239. [PMID: 6697132]
Teo LL, Venkatesh SK, Ho KY. Clinics in diagnostic imaging. Singapore Med J 2007; 48:687-692. [PMID: 17609835]
Abid M, Guirat A, Ayadi L, Mzali R, Ben Amar M, Beyrouti MI. Pancreatic tuberculosis: a rare cause of pseudoneoplasic obstructive jaundice. Presse Med 2009; 38:e7–10. [PMID: 19167862]
Jenney AW, Pickles RW, Hellard ME, Spelman DW, Fuller AJ, Spicer WJ. Tuberculous pancreatic abscess in an HIV antibody-negative patient: case report and review. Scand J Infect Dis 1998; 30:99-104. [ PMID: 9730291]
Porter AE The Bacteriolytic Action of Gland Extracts on Tubercle Bacilli. J Hyg (Lond) 1917; 16:55-65. [PMID: 20474643].
Day AA, Gibbs WM The action of pancreatic juice on bacteria .The Journal of Infectious Diseases 1930:26-30. [http://goo.gl/6ZfPoi]
Franco-Paredes C, Leonard M, Jurado R, Blumberg HM, Smith RM. Tuberculosis of the pancreas: report of two cases and review of the literature. Am J Med Sci 2002; 323:54-8. [PMID: 11814144]
Cho SB. Pancreatic tuberculosis presenting with pancreatic cystic tumor: a case report and review of the literature. Korean J Gastroenterol 2009; 53:324-8. [PMID: 19458471]
Santhosh S, Bhattacharya A, Rana SS, Bhasin DK, Srinivasan R, Mittal BR. Pancreatic tuberculosis: Evaluation of therapeutic response using F-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography .Indian J Nucl Med 2014; 29:257-9. [PMID: 25400368]
Saluja SS, Ray S, Pal S, Kukeraja M, Srivastava DN, Sahni P, Chattopadhyay TK. Hepatobiliary and pancreatic tuberculosis: a two decade experience. BMC Surg 2007; 7:10. [PMID: 17588265]
Sinan T, Sheikh M, Ramadan S, Sahwney S, Behbehani A: CT features in abdominal tuberculosis: 20 years experience. BMC Med Imaging 2002, 2:3-10. [PMID: 12427257]
Stock KP, Riemann JF, Stadler W, Rösch W. Tuberculosis of the pancreas. Endoscopy 1981; 13:178-180.[ PMID: 7250088]
Rana SS, Bhasin DK, Rao C, et al. Isolated pancreatic tuberculosis mimicking focal pancreatitis and causing segmental portal hypertension. JOP 2010 11:393-5. [PMID: 20601818]
Rana SS, Sharma V, Sampath S, Sharma R, Mittal BR, Bhasin DK. Vascular invasion does not discriminate between pancreatic tuberculosis and pancreatic malignancy: a case series. Ann Gastroenterol 2014; 27:395-398. [PMID: 25331582]
Huang CT, Lo CY, Lee TH. Isolated peripancreatic tuberculous lymphadenopathy: a rare manifestation of abdominal tuberculosis mimicking pancreatic cystic neoplasm. J Dig Dis 2013; 14:105-8. [PMID: 23121697]
Falkowski AL, Graber J, Haack HG, Tarr PE, Rasch H. Isolated pancreatic tuberculosis: a case report and radiological comparison with cystic pancreatic lesions. J Radiol Case Rep 2013; 7:1-11. [PMID: 23372869]
Pombo F, Díaz Candamio MJ, Rodriguez E, Pombo S. Pancreatic tuberculosis: CT findings. Abdom Imaging 1998; 23:394-397. [PMID: 9663275]
Takhtani D, Gupta S, Suman K, Kakkar N, Challa S, Wig JD, Suri S. Radiology of pancreatic tuberculosis: a report of three cases. Am J Gastroenterol 1996; 91:1832-1834. [PMID: 8792708]
Pateron D, Naveau S, Brivet F, Bedossa P, Poynard T, Chaput JC. Acute tuberculous pancreatitis in a patient with acquired immunodeficiency syndrome. Gastroenterol Clin Biol 1990; 14:80-83. [PMID: 2179013]
Caminal Montero L, Rubiales AS, Marroquín AG, Trapiella Martínez L, Telenti Asensio M. Tuberculous pancreatitis in HIV infection. An Med Interna 1998; 15:338-339. [PMID: 9656519]
Cappell MS, Javeed M. Pancreatic abscess due to mycobacterial infection associated with the acquired immunodeficiency syndrome. J Clin Gastroenterol 1990; 12:423-429. [PMID: 2204652]
Cho KC, Lucak SL, Delany HM, Morehouse HT, Jennings TA. CT appearance in tuberculous pancreatic abscess. J Comput Assist Tomogr 1990; 14: 152-154. [ PMID: 2298985]
Desmond NM, Kingdon E, Beale TJ, Coker RJ, Tanner AG, Harris JW. Tuberculous pancreatic abscess: an unusual manifestation of HIV infection. J R Soc Med 1995; 88: 109-110. [PMID: 7769586]
Molina M, Ortega G, Redondo C, Galera C, Pérez Luján YR. Tuberculous abscess of the pancreas as initial manifestation of AIDS. Gastroenterol Hepatol 1997; 20:165-166. [PMID: 9162543]
Cheng J, Tadi K, Halpern M, Feurdean M, McNelis J, Brensilver J. Pancreatic tuberculosis in a human immunodeficiency virus positive patient: a case report. World J Gastroenterol 2008; 14:939-940. [PMID: 18240354]
Eyal AS, Karusseit VO. Tuberculosis of the pancreas mimicking carcinoma. Int J Infect Dis 2008; 12:108-110. [PMID: 17587622]
Fenkel JM, Spodik M, Singu BS, Infantolino A, Deshmukh SP, Loren DE. Tubercular pancreatic abscess presenting as Fever and cystic pancreatic lesion with endoscopic management. Dig Dis Sci 2010; 55:2118-2120. [PMID: 19693668]
Jaber B, Gleckman R. Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review. Clin Infect Dis 1995; 20:890-894. [PMID: 7795090]
Jena GP, Manoharan GR, Mbete DL, Pillay SS. Tuberculous pancreatic abscess in HIV-positive patients. A report of 3 cases and a review of the literature. S Afr J Surg 1999; 37:69-71. [PMID: 10540573]
Bascuñana A, Torres Tortosa M, Pérez Pérez M, López Cano A, Rendón P, Pérez Millán E. Abdominal tuberculous abscesses in patients with acquired immunodeficiency syndrome: description of 5 cases. Med Clin (Barc) 1990; 95:259-261. [PMID: 15717764]
Loya AC, Prayaga AK, Sundaram C, Shantharam V, Kumar A. Cytologic diagnosis of pancreatic tuberculosis in immunocompetent and immunocompromised patients: a report of 2 cases. Acta Cytol 2005; 49:97-100. [PMID: 15717764]
De Backer AI, Mortelé KJ, Bomans P, De Keulenaer BL, Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol 2005; 184:50-54. [PMID: 15615950]
Rana SS, Bhasin DK, Srinivasan R, Sampath S, Mittal BR, Singh K. Distinctive endoscopic ultrasound features of isolated pancreatic tuberculosis and requirements for biliary stenting. Clin Gastroenterol Hepatol 2012; 10:323-325. [PMID: 22037426]
Sharma V, Rana SS, Bhasin DK. Endoscopic ultrasound guided fi ne needle aspiration for diagnosis of pancreatic tuberculosis. JOP 2013; 14:521. [PMID: 24018601]
Rao C, Rana SS, Bhasin DK. Endoscopic ultrasound and pancreatic tuberculosis. J Gastrointestin Liver Dis 2012; 21:439-440. [PMID: 23256131]
Martínez AQ, DeCruz P, Murugananthan A, Desmond P, Chen R. Endoscopic ultrasound-guided fine needle aspirate: a useful method in the diagnosis of pancreatic tuberculosis. ANZ J Surg 2012; 82:282-283. [PMID: 22510191]
Chatterjee S, Schmid ML, Anderson K, Oppong KW. Tuberculosis and the pancreas: a diagnostic challenge solved by endoscopic ultrasound. A case series. J Gastrointestin Liver Dis 2012; 21:105-107. [PMID: 22457868]
Levine R, Tenner S, Steinberg W, Ginsberg A, Borum M, Huntington D. Tuberculous abscess of the pancreas. Case report and review of the literature. Dig Dis Sci 1992; 37:1141-1144. [PMID: 1618064]
Ahlawat SK. EUS-guided FNA diagnosis of pancreatic tuberculosis. Gastrointest Endosc 2007; 65:557-558. [PMID: 17321273]
Coriat R, Latournerie M, Galtier JB, Michiels C, Hillon P, Manfredi S. The role of echoendoscopic biopsy in diagnosing tuberculosis of pancreas. Gastroenterol Clin Biol 2008; 32:98-101. [PMID: 18341981]
Song TJ, Lee SS, Park do H, Lee TY, Lee SO, Seo DW, Lee SK, Kim MH. Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis. Gastrointest Endosc 2009; 69: 484-491. [PMID:19231490]
Raghavan P, Rajan D. Isolated pancreatic tuberculosis mimicking malignancy in an immunocompetent host. Case Rep Med 2012; 2012:501246. [PMID: 22761624]
Yavuz A, Buluş H, Aydin A, Coşkun A. Pancreatic tuberculosis mimicking inoperable pancreatic cancer. Turk J Gastroenterol 2012; 23:95-97. [PMID:22505394]
Rao RN, Pandey R, Rana MK, Rai P, Gupta A. Pancreatic and peripancreatic tuberculosis presenting as hypoechoic mass and malignancy diagnosed by ultrasound-guided fine-needle aspiration cytology. J Cytol 2013; 30:130-5. [PMID: 23833404]
Beger HG, Warshaw AL, Büchler MW, Kozarek RA, Lerch MM, Neoptolemos JP, Shiratori K, Whitcomb DC, Rau BM, editors. The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery. 2nd ed. Oxford: Blackwell Publishing, 2008: 321-330. http://goo.gl/g6PaOV.
Rana SS, Chaudhary V, Gupta N, Sampath S, Mittal BR, Bhasin DK. Pancreatic tuberculosis presenting as an unusual head mass. Endoscopy. 2013;45 Suppl 2 UCTN:E317-8. [PMID: 24008485]
Yang YJ, Li YX, Liu XQ, Yang M, Liu K. Pancreatic tuberculosis mimicking pancreatic carcinoma during anti-tuberculosis therapy: A case report. World J Clin Cases 2014; 2:167-9. [PMID: 24868519]
Copyright (c) 2015 Mohammad Bagher Miri, Mohammad Taghi Safari, Amir Houshang Mohammad Alizadeh
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.