Hoilat Gilles J, Abdu Manasik, Hoilat Judie, Gitto Lorenzo, Bhutta Abdul Q
Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA.
Internal Medicine, Alfaisal University, Riyadh, SAU.
Cureus. 2020 Jun 24;12(6):e8795. doi: 10.7759/cureus.8795.
Pancreatic tuberculosis (TB) is a very rare condition even in endemic areas of the world where the disease is considered to be highly prevalent. The presenting features are usually vague and its radiological features mimic pancreatitis and pancreatic malignancy. We present a case of a 26-year-old active military male, originally from Virginia with no past medical history who presented to the ED with a two-week history of abdominal pain, increased nausea and vomiting, decreased appetite, increased darkening of his urine, and pale-colored stools. His physical examination was remarkable for conjunctival icterus as well as generalized abdominal tenderness. His laboratory results were remarkable for a total bilirubin of 4.7 mg/dL, direct bilirubin of 3.9 mg/dL, and alkaline phosphatase of 583 U/L. A CT scan was performed showing an intrahepatic dilatation and abrupt obstruction of the common bile duct at the level of a mass. Subsequent MRI of the abdomen was performed which showed a pancreatic mass at the uncinate process obstructing the common bile duct and causing intrahepatic bile dilation. The patient was deemed a surgical candidate and endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic ultrasound (EUS) was performed for the sake of staging and showed a biliary compression in the middle of the common bile duct for which a stent was placed, and fine-needle aspiration (FNA) of the pancreatic mass was performed which was consistent with necrotizing granulomatous lymphadenitis. After further diagnostic studies, the patient was diagnosed with pancreatic TB. This case highlights the unusual presentation of extrapulmonary TB as well as the importance of EUS-guided FNA in diagnosing pancreatic TB which was presumed to be a malignant mass and candidate for unnecessary surgical resection.
胰腺结核即使在世界上该疾病被认为高度流行的 endemic 地区也是一种非常罕见的病症。其呈现的特征通常不明确，放射学特征类似胰腺炎和胰腺恶性肿瘤。我们报告一例26岁现役男性军人病例，他来自弗吉尼亚州，既往无病史，因腹痛两周、恶心呕吐加重、食欲减退、尿色加深及大便颜色变浅而到急诊科就诊。他的体格检查显示结膜黄疸以及全腹压痛明显。他的实验室检查结果显示总胆红素为4.7mg/dL、直接胆红素为3.9mg/dL、碱性磷酸酶为583U/L。进行了CT扫描，显示肝内胆管扩张以及在肿块水平处胆总管突然梗阻。随后进行了腹部MRI检查，显示在钩突部有一个胰腺肿块，阻塞了胆总管并导致肝内胆管扩张。该患者被认为是手术候选者，为了分期进行了内镜逆行胰胆管造影（ERCP）/内镜超声（EUS）检查，结果显示胆总管中部有胆管受压，为此放置了支架，并对胰腺肿块进行了细针穿刺抽吸（FNA），结果与坏死性肉芽肿性淋巴结炎一致。经过进一步的诊断研究，该患者被诊断为胰腺结核。本病例突出了肺外结核的不寻常表现以及EUS引导下FNA在诊断胰腺结核中的重要性，胰腺结核最初被认为是恶性肿块并可能接受不必要的手术切除。
