Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: A case report

Abstract

Tuberculosis (TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and pre-operative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting image-guided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacilli on Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.

Keywords: Pancreatic tuberculosis; Pancreatic mass; Pre-operative diagnosis; Computed tomography; Fine needle aspiration; Antituberculous drugs

Core tip: Isolated pancreatic tuberculosis is rare, even in countries with a high incidence of tuberculosis. Pancreatic tuberculosis (TB) is more frequently associated with miliary TB or widely disseminated disease. Pancreatic tuberculosis most commonly presents as a solitary lesion with multiple cystic components. The most important differential diagnosis includes pancreatic malignancy. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and pre-operative diagnosis is quite difficult. In the present study, we describe a rare case of isolated pancreatic TB in a 24-year-old man, presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography (CT) and fine needle aspiration of the pancreatic mass revealed acid-fast bacilli. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis.