Pancreatic Tuberculosis Mimicking Pancreatic Cancer in a Young Immunocompetent Man: A Case Report and Literature Review

Abstract

Background Pancreatic TB is extremely rare, even in endemic areas. Clinically and radiographically, it may resemble a malignant process. Herein, we present a case of pancreatic TB who underwent surgery with a preoperative diagnosis of pancreatic malignancy. Case Presentation A 34-year-old Afghan man presented with a one-year history of intermittent epigastric pain, accompanied by nausea and vomiting. Physical examination showed stable vital signs with mild epigastric tenderness. Laboratory examinations revealed mild anemia with mildly increased liver enzymes and lipase. The CA19-9 level in serum was mildly elevated, and the serologic test for HIV antibody was negative. An abdominal CT scan revealed a 57×30 mm multiloculated hypoattenuating mass-like lesion in the head of the pancreas with no evidence of biliary system dilation. As EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) was not available at our institution and the lesion was highly suspicious for pancreatic malignancy, the patient underwent Whipple resection. On macroscopic examination, a well-defined creamy soft mass with necrotic consistency was found in the head of the pancreas. Microscopic examination showed significant caseating granulomatous inflammation containing Langhans giant cells, and the Ziehl–Neelsen staining revealed a large number of acid-fast positive bacilli in favor of Mycobacterium tuberculosis. Anti-TB medicine was administered. No clinical or radiologic deficits were discovered during the 10-month follow-up visits. Conclusion Pancreatic TB should be considered a differential diagnosis in pancreatic lesions, particularly in young patients from tuberculosis-endemic areas. Whenever feasible, preoperative EUS-guided FNA/FNB combined with microbiologic study may help avoid unnecessary invasive surgeries.