Abdominal tuberculosis with pancreatic head involvement mimicking pancreatic malignancy in a young man: A case report

Abstract

Background: Pancreatic tuberculosis (PTB) is a rare disease, even in immunocompetent hosts. Abdominal tuberculosis involving the pancreatic head and peripancreatic areas may simulate pancreatic head carcinoma.

Case summary: We present the case of a 32-year-old man who was admitted to our hospital for intermittent epigastric pain and weight loss. A computed tomography scan and magnetic resonance imaging revealed a mass in the head of the pancreas. The lesion was initially diagnosed as pancreatic head carcinoma on abdominal imaging. Laparotomy confirmed the diagnosis of PTB and the patient received antituberculosis therapy.

Conclusion: The present case is reported to emphasize the importance of including PTB in the differential diagnosis of pancreatic lesions.

Keywords: Case report; Computed tomography; Laparotomy; Pancreatic head carcinoma; Pancreatic tuberculosis.

Figure 1

Contrast-enhanced computed tomography scan. A: An ill-defined mass with peripheral rim enhancement and internal low density in the head of the pancreas (left panel, black arrow); B: A coronal computed tomography scan revealing that the portal vein was partially encased by the lesion (right panel, white arrow).

Figure 2

Magnetic resonance imaging result. A: The portal vein is locally narrowed due to compression by the mass (left panel, black arrow); B: Magnetic resonance cholangiopancreatography revealing a stricture of the distal common bile duct (right panel, white arrow).

Figure 3

On laparotomy, tissue with caseous necrosis is identified above the pancreatic head (arrows).

Figure 4

Pathological examination showing epithelioid granulomatous inflammation with caseous necrosis, composed of epitheloid cells and occasional multinucleated giant cells (arrow). Hematoxylin and eosin staining; magnification, × 100.