Isolated pancreatic tuberculosis mimicking malignancy in an immunocompetent host

Abstract

Despite the high prevalence of tuberculosis (TB) worldwide, pancreatic TB is rare. When present, pancreatic TB is frequently associated with miliary TB, often in immunocompromised hosts. Pancreatic TB may present as a pancreatic abscess, acute or chronic pancreatitis, and cystic or solid pancreatic masses. We present a case of an immunocompetent patient who presented with two discrete pancreatic masses and was subsequently diagnosed with isolated pancreatic TB. This case suggests that clinicians should have a heightened suspicion of pancreatic TB when faced with discrete pancreatic lesions, especially in patients from areas where the infection is endemic. Such recognition may lead to appropriate diagnostic testing, and possible resolution of pancreatic lesions with antituberculin therapy.

Figure 1

Acomplex cystic mass with thick-walled irregular septations indenting the head of the pancreas (arrow), mimicking the appearance of a cystic neoplasm.

Figure 2

A complex cystic lesion with an internal septation in the splenic porta lying between the tail of the pancreas and the spleen (arrow).

Figure 3

Cell block prepared from the fine needle aspirate of the mass seen in the pancreatic head. Note the appearance of lymphohistiocytic aggregates suggestive of granulomatous inflammation.