Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 14, 2008; 14(6): 939-940
Published online Feb 14, 2008. doi: 10.3748/wjg.14.939
Pancreatic tuberculosis in a human immunodeficiency virus positive patient: A case report
Jianfeng Cheng, Kiranmayi Tadi, Michelle Halpern, Mirela Feurdean, Joseph McNelis, Jeffrey Brensilver
Jianfeng Cheng, Kiranmayi Tadi, Michelle Halpern, Mirela Feurdean, Joseph McNelis, Jeffrey Brensilver, Department of Medicine, Sound Shore Medical Center of Westchester, 16 Guion Place, New Rochelle, NY 10801, United States
Correspondence to: Jianfeng Cheng MD, PhD, Department of Medicine, Sound Shore Medical Center of Westchester, 16 Guion Place, New Rochelle, NY 10801, United States. jcheng794@gmail.com
Telephone: +1-347-3068322
Fax: +1-914-3655489
Received: July 8, 2007
Revised: August 20, 2007
Published online: February 14, 2008
Abstract

Despite the increased incidence of tuberculosis related to human immunodeficiency virus (HIV) in recent decades, pancreatic tuberculosis has rarely been described. We report a case of pancreatic tuberculosis in a 39-year-old African man who presented with progressive dysphagia, vomiting, weight loss and productive cough, accompanied by localized epigastric pain and one episode of melena. HIV-1 testing was positive and lymphocyte subset profile showed CD4 count of 9/mm3. Abdominal computed tomography (CT) scan with contrast revealed a cystic mass in the body of the pancreas, significant portal and retroperitoneal cystic adenopathy, and multiple cystic lesions in the spleen and liver. CT guided cyst aspiration and node biopsy detected Mycobacterium tuberculosis. The patient responded well on antituberculosis and antiretroviral therapy. Tuberculosis rarely involves the pancreas, probably due to the presence of pancreatic enzymes which interfere with the seeding of Mycobacterium tuberculosis. Pancreatic tuberculosis is considered to be the result of dissemination of the infection from nearby lymphatic nodes. Endoscopic ultrasound or CT guided fine needle aspiration for cytology is the recommended diagnostic technique. Although the prognosis is good with anti-tuberculosis treatment, it could be fatal without correct diagnosis and treatment. The clinician’s high index of suspicion of pancreatic tuberculosis and application of FNAB to obtain pathological evidence are extremely important to a correct diagnosis, especially in young HIV positive patients.

Keywords: Pancreatic tuberculosis; Human immun-odeficiency virus infection; CT-guided fine needle biopsy