Isolated pancreatic tuberculosis with duodenal fistula: A case report

Abstract

Significance: Isolated pancreatic tuberculosis (TB) is an uncommon form of gastrointestinal TB even in endemic countries.1 It is reported in less than 5% of cases and occurs usually in disseminated TB and immunocompromised conditions. Symptoms include abdominal pain, fever, and weight loss. Its appearance on radiologic imaging can mimic pancreatic malignancy, becoming a diagnostic challenge. In this case report, we present a case of isolated pancreatic TB presenting as pancreatic mass in imaging studies, mimicking as malignancy.

Clinical Presentation: Our patient is a 56-year-old Filipino male, immunocompetent, and without known comorbidities. He presented with fever and chills, epigastric pain, poor appetite, and weight loss, and epigastric tenderness on examination.

Management: A contrast enhanced CT scan and MRI of the abdomen showed pancreatic mass with prominent lymph nodes. An EUS-guided FNA of the said mass revealed a pancreatic cystic mass at the uncinate process with noted fistulous tract to the duodenum. A re-biopsy was done at the fistulous tract in the duodenum to collect more samples for TB work-up for a more definitive diagnosis. He was then managed as isolated pancreatic TB with fistulous tract formation to the duodenum and was treated successfully with anti-tuberculous drugs. On follow up after three months, there was weight gain, resolution of fever and abdominal pain.

Recommendation: Pancreatic tuberculosis presenting as pancreatic mass may mimic malignancy leading to misdiagnosis. Providing enough tissue samples to establish TB is warranted to guide us in managing these patients and avoid unnecessary surgery.