Pancreatic tuberculosis: A case report and review of literature

Table 1 Results of biochemical tests, inflammatory markers, and infectious disease screening after admission

Parameter	Result (reference values)
Biochemical test
ALT, U/L	53 (9-50)
AST, U/L	20 (15-40)
ALP, U/L	132 (45-125)
GGT U/L	113 (10-71)
LPS, IU/L	66.6 (13.00-60.00)
p-AMY U/L	71 (15-53)
Inflammatory markers
CRP, mg/L	47.3 (< 1)
Infectious disease screening
HIV	Negative
HBV	Negative
HCV	Negative

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; LPS: Lipase; p-AMY: Ancreatic amylase; CRP: C-reactive protein; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Diagnostic methods and outcome in the present case

Diagnostic method	Details	Outcome
Clinical presentation	Abdominal pain, weight loss, fever, jaundice, and anorexia	Nonspecific symptoms leading to initial misdiagnosis
Imaging (computed tomography/endoscopic ultrasound)	Imaging showed a pancreatic mass, suggestive of malignancy	Mass located in the head of the pancreas
Endoscopic ultrasound-guided fine needle aspiration	Biopsy performed to obtain esophageal tissue	Identified granulomas; supported tuberculosis diagnosis
Histopathological examination	Granulomas observed on biopsy; caseating necrosis suspected	Confirmed tuberculosis via granuloma presence
Molecular testing (PCR)	PCR testing for Mycobacterium tuberculosis performed	Positive result confirmed pancreatic tuberculosis diagnosis

PCR: Polymerase chain reaction.

Table 3 Liver function parameters following anti-tuberculosis treatment and subsequent hepatoprotective therapy

Parameter	After anti-tuberculosis treatment initiation	Post-hepatoprotective treatment	After 1 month of treatment
ALT, U/L (9-50)	332	89	7
AST, U/L (15-40)	349	45	17
CB, μmol/L (≤ 6.89)	11.7	6.1	5.5
UCB, μmol/L (≤ 16.8)	7.3	3.0	11.2
ALP, U/L (45-125)	296	197	80
GGT, U/L (10-71)	484	142	35

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CB: Conjugated bilirubin; UCB: Unconjugated bilirubin; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase.

Table 4 Demographics and symptoms in 92 patients diagnosed with pancreatic tuberculosis, n (%)

Variables	Value
Age, years	41.12 ± 15.74
Age range, years	11-86
Sex
Male	52 (56.5)
Female	40 (43.5)
Origin
Asia	44 (47.8)
Africa	17 (18.5)
Europe	18 (19.6)
North America and New Zealand	7 (7.6)
South America	3 (3.3)
HIV-positive	6 (6.5)
Previous tuberculosis	2 (2.2)
Symptoms
Fever	30 (32.6)
Epigastric pain	68 (73.9)
Night sweats	9 (9.8)
Weight loss	47 (51.1)
Jaundice	16 (17.4)
Fatigue	6 (6.5)
Anorexia/nausea/vomiting	33 (35.9)
Distribution
Pancreatic head	64 (69.6)
Pancreatic body	17 (18.5)
Pancreatic tail	12 (13.0)
Pancreatic neck	1 (1.1)

HIV: Human immunodeficiency virus.

Table 5 Diagnostic modalities for pancreatic tuberculosis among the 92 reported cases, n (%)

Diagnostic modalities	Value
Endoscopic ultrasound-guided fine-needle aspiration	39 (42.4)
Computed tomography-guided fine-needle aspiration	11 (12.0)
Exploratory laparotomy	36 (39.1)

Table 6 Treatment modalities for patients with pancreatic tuberculosis, n (%)

Treatment	Value
Pharmacological	78 (84.8)
Surgical + pharmacological	11 (12.0)
Surgical	2 (2.2)

Table 7 Clinical outcomes of patients with pancreatic tuberculosis, n (%)

Outcome	Value
Cured	83 (90.2)
Secondary pulmonary tuberculosis	1 (1.1)
Died	1 (1.1)