An Unusual Cause of Pancreatic Tumor

TL;DR

A rare case of pancreatic tuberculosis was correctly diagnosed and successfully treated with anti-TB medications.

Contribution

This case highlights the importance of using EUS with FNA for diagnosing rare pancreatic conditions like tuberculosis.

Findings

Pancreatic tuberculosis was confirmed through EUS with FNA and fluid culture.

Anti-TB treatment led to normalization of inflammatory markers and complete resolution of the lesion.

EUS with FNA is a valuable diagnostic tool for distinguishing TB from pancreatic tumors.

Abstract

Pancreatic tuberculosis (TB) is a rare condition that can be challenging to distinguish from other pancreatic neoplasms. We present the case of a 48-year-old Indian male who complained of persistent vague epigastric pain for two months. Other physicians saw him and treated him like a dyspeptic case. He gave a history of daily alcohol consumption.

Routine investigations, including amylase and lipase levels, were within normal limits. However, an abdominal ultrasound revealed a cystic lesion in the body of the pancreas, prompting further investigation. A subsequent abdominal CT scan revealed a tumor of 6x4 cm in diameter with solid and cystic components in the pancreatic body. Although tumor markers were not remarkable, inflammatory markers showed elevated levels of ESR (erythrocyte sedimentation rate) of 95 mm/hr and CRP (C-reactive protein) of 83 mg/L, with normal hemoglobin. Endosonography (EUS) with fine needle aspiration (FNA) was performed to achieve a definitive diagnosis. EUS was performed with a linear echoendoscope, which revealed the mass, which had solid and cystic components. Fluid was aspirated from the cystic part and FNA passes were performed in the solid part.

Microscopic examination and aspirated fluid culture confirmed the presence of Mycobacterium tuberculosis, while the solid part revealed caseation-indicated granulomas, indicative of TB.

The patient was promptly initiated on a seven-month course of three anti-TB medications, leading to normalization of ESR and CRP levels during the treatment period. A follow-up abdominal CT scan showed complete resolution of the pancreatic lesion, indicating successful management.

This case is rare and all the data in the literature is mainly in the form of case reports. Using EUS with FNA has transformed the diagnosis of pancreatic malignancy into a curable disease that could be easily managed with anti-TB medications.

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