Pancreatic Tuberculosis Mimicking Pancreatic Cancer in a Young Immunocompetent Man: A Case Report and Literature Review.
Kourosh Kazemi, Neda Soleimani, Mehran Jafari et al.
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Case in brief
A 34-year-old HIV-seronegative Afghan man had a year of intermittent epigastric pain, nausea, and vomiting. CT showed a 57×30 mm multiloculated hypoattenuating mass in the pancreatic head without biliary dilation; serum CA19-9 was mildly elevated. With EUS-guided sampling unavailable and malignancy suspected, he underwent Whipple resection. Histology showed caseating granulomas with Langhans giant cells, and Ziehl-Neelsen staining identified numerous acid-fast bacilli, supporting pancreatic tuberculosis. He received anti-tuberculosis medication, with no clinical or radiologic deficits reported during 10 months of follow-up.
What made this case unusual
Pancreatic tuberculosis presented as a mass suspicious for cancer and led to pancreatic resection; tissue examination instead showed caseating granulomatous inflammation with acid-fast bacilli.
Diagnostic / clinical pearl
A pancreatic mass in a young patient from a tuberculosis-endemic area can represent tuberculosis, even when imaging and mildly elevated CA19-9 raise concern for malignancy. Where feasible, preoperative EUS-guided sampling with microbiologic study may help establish the diagnosis.