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- W2978073511 abstract "Tuberculosis (TB) is a systemic disease that can affect any organ. While abdominal TB is common in endemic countries, pancreatic tuberculosis is rare. Its clinical and radiologic features may mimic pancreatic malignancy, making it difficult to diagnose clinically. A 31 year-old previously healthy man presented with fevers, epigastric pain, poor appetite, night sweats and a 12 kilogram weight loss over 1 year. The patient denied a history of tuberculosis. Abdominal MRI revealed a 3cm x 4cm mass indenting the pancreatic head and uncinate process and compressing the mid-common bile duct. Lab work showed a white blood cell count of 12,200 cells/ul, amylase of 152 mg/dL, and lipase of 623 U/L. Malignancy workup including CA 19-9, CA 125, and alpha fetoprotein was negative. Quantiferon gold was positive. The chest x-ray was unremarkable. Endoscopic ultrasoundguided fine needle aspiration (EUS-FNA) of the pancreatic head mass was performed (Figure 1). Pathology revealed caseating granulomas and a positive acid-fast bacilli stain. The patient was treated with rifampin, isoniazid, pyridoxine and ethambutol for 14 months. Follow up MRI one year after starting treatment showed resolution of the pancreatic head mass.Figure 1While TB is a health concern worldwide, isolated pancreatic TB is uncommon even in endemic areas. The prevalence of pancreatic TB is similar in males and females with a mean age of 40 years. A large case series evaluating abdominal TB reported no cases of pancreatic TB. Patients may present with obstructive jaundice and a pancreatic mass clinically indistinguishable from a pancreatic neoplasm. Consequently, most previously reported cases were diagnosed after exploratory laparotomy for pancreatic malignancy. Pancreatic TB most commonly affects the head or body of the pancreas. There are no radiologic features pathognomonic for pancreatic TB. Typically, pancreatic lesions from TB are heterogeneous and multicystic. The diagnosis of pancreatic TB requires histologic, cytologic and bacteriologic confirmation. EUS-FNA is the diagnostic modality of choice. Treatment with 6-12 months of anti-tuberculosis therapy is effective. Isolated pancreatic TB is a rare disease that must be considered in the differential diagnosis of a pancreatic mass, especially in endemic regions. A high index of suspicion and an accurate diagnostic approach with EUS- or CT-guided FNA are necessary." @default.
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- W2978073511 date "2015-10-01" @default.
- W2978073511 modified "2023-10-18" @default.
- W2978073511 title "A Rare Case of Isolated Pancreatic Tuberculosis" @default.
- W2978073511 doi "https://doi.org/10.14309/00000434-201510001-00168" @default.
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