Pancreatic Tuberculosis: Current Update on Clinical Manifestation and Diagnostic Modalities

Pancreatic tuberculosis is a very rare disease in either immunocompetent or immunocompromised hosts.The incidence of pancreatic tuberculosis was reported to be less than 4.7% in an autopsy series on tuberculosis patients in 1944 and 2% in another autopsy series in 1966.Despite that, in recent times, an increase in the number of reports of pancreatic TB has been noted.This condition is possibly caused by an improvement in diagnostic imaging tools, the development of different techniques that make obtaining specimens from the pancreas possible, and an increase in HIV prevalence worldwide. Therefore, this review article discusses the current update in the clinical manifestations and diagnostic modalities of pancreatic tuberculosis.Pancreatic tuberculosis is a very rare condition with a various range of non-specific clinical presentation and image features overlapping with those seen in pancreatic neoplasia. A combination of diagnostic modalities should be done to establish a diagnosis of pancreatic tuberculosis. Currently, direct histopathological examination is the best way of diagnosing tuberculosis. US/CT/EUS-guided biopsy is the recommended diagnostic technique. Most patients with pancreatic tuberculosis respond well to anti-tuberculosis drugs.

Isolated pancreatic tuberculosis presenting as obstructive jaundice

A 36-year-old male patient presented in surgical clinic with complaints of abdominal pain and progressively increasing yellowish discoloration of his skin and sclera for last 1 month. He was deeply jaundiced with mild tenderness in epigastric region. He had a strong family history of tuberculosis. Diagnostic work-up revealed obstructive jaundice secondary to pancreatic tuberculosis. Tomographic examination revealed a pancreatic head mass with peripancreatic lymphadenopathy. Endoscopic ultrasound (EUS) showed a mass at pancreatic head region & EUS guided fine needle aspiration revealed tuberculosis. Patient was started on anti-tubercular therapy with gradual improvement of symptoms over the course of treatment.

A DIAGNOSTIC PITFALL: PANCREATIC TUBERCULOSIS MASQUERADING AS PANCREATIC CARCINOMA

Isolated cases of Pancreatic Tuberculosis remains a rare entity even in countries with a high incidence of Tuberculosis. It presents as a hypoechoic mass on ultrasonography and imaging mimicking pancreatic malignancy. Consequently, it represents a diagnostic challenge both clinically (due to a similar array of symptoms) and radiologically. The diagnosis often requires tissue biopsy. The possibility of TB should be considered in the list of differential diagnoses of pancreatic mass and an endoscopic, ultrasound-guided biopsy might help to clinch the diagnosis of this potentially curable disease. Here, we report a case with symptoms of abdominal pain, progressive jaundice, and anorexia and weight loss, diagnosed to be a case of Disseminated Tuberculosis (Pancreatic TB) following Endoscopic Ultrasound guided FNAC of peri-pancreatic lymph nodes.