Puzzling Clinical Appearance of a Pancreatic Tuberculosis Case

Authors

  • Anak Agung Fendy Tri Wicaksana Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Bramantono Bramantono Division of Tropical & Infectious Disease, Department of Internal Medicine, Dr. Soetomo General/Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
  • Musofa Rusli Division of Tropical & Infectious Disease, Department of Internal Medicine, Dr. Soetomo General/Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
  • M Vitanata Arfijanto Division of Tropical & Infectious Disease, Department of Internal Medicine, Dr. Soetomo General/Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
  • Usman Hadi Division of Tropical & Infectious Disease, Department of Internal Medicine, Dr. Soetomo General/Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia

Keywords:

Pancreatic tuberculosis, granuloma, Ziehl Nelsen, Anti-tuberculosis drug

Abstract

Tuberculosis (TB) is generally known as an infectious disease caused by Mycobacterium tuberculosis. Not only the lungs, TB can also infect various other organs. Pancreatic TB is a rare manifestation of extrapulmonary TB infection accounting for only 0-4.7% of the total TB cases worldwide. It’s still intricating for clinicians to diagnose pancreatic TB due to the extremely rare prevalence and non-specific clinical signs and symptoms. Herein we report a 71-year-old male patient complaining of jaundice and weight loss. Clinical condition, laboratory and tumor markers, also MRI imaging showed no abnormality. We made the diagnosis through histopathological examination of tissues extracted from bypass biliodigestive procedure, showing granulomas, along with confirmed bacteriological analysis with Ziehl Nelsen staining. This patient received Fixed Drug Combination (FDC) of anti-tuberculosis therapy for 6 months. The patient gained weight, had an improvement of serum bilirubin level and had no remaining lesion in abdominal CT scan.

References

Motsoaledy A MP. National Tuberculosis Management Guideline. Fiswicks PTA. 2014.

Samuel DO, Majid Mukhtar AA, Philip IO. A diagnostic pitfall: pancreatic tuberculosis, not pancreatic cancer. J Coll Physicians Surg Pak. 2013;23(3):211-3.

Henrique Pereira Faria JTA, Ovídio Carlos Carneiro Villela, Raul Moraes da França Filho, Milton Alves Romeiro. Pancreatic Tuberculosis: A case report and literature review. Radiol Bras. 2007;40:143-5.

Ibrahim GF, Al-Nakshabandi NA. Pancreatic Tuberculosis: Role of multidetector computed tomography. Canadian Association of Radiologists Journal. 2011;62(4):260-4.

Kim JB, Lee SS, Kim SH, et al. Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: a single-center experience. J Gastroenterol Hepatol. 2014;29(2):409-16.

Sharma V, Rana SS, Kumar A, Bhasin DK. Pancreatic tuberculosis. J Gastroenterol Hepatol. 2016;31(2):310-8.

Subuh M PS, Widaningrum C, Dinihari NT, Siagian V. Pedoman nasional pengendalian Tuberkulosis. Kementrian Kesehatan Republik Indonesia. 2011.

Pandita KK, Sarla, Dogra S. Isolated pancreatic tuberculosis. Indian Journal of Medical Microbiology. 2009;27(3):259-60.

Shabnam Shahrokh MBM, Mohammad Taghi Safari, Amir Houshang Mohammad Alizadeh. Pancreatic Tuberculosis: An overview. Journal of Pancreas. 2015;16(3):232-8.

Nagar AM, Raut AA, Morani AC, Sanghvi DA, Desai CS, Thapar VB. Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr. 2009;33(1):136-41.

Rana SS, Bhasin DK, Srinivasan R, Sampath S, Mittal BR, Singh K. Distinctive endoscopic ultrasound features of isolated pancreatic tuberculosis and requirements for biliary stenting. Clin Gastroenterol Hepatol. 2012;10(3):323-5.

Takhtani D, Gupta S, Suman K, et al. Radiology of pancreatic tuberculosis: a report of three cases. Am J Gastroenterol. 1996;91(9):1832-4.

Puri R, Thandassery RB, Eloubeidi MA, Sud R. Diagnosis of isolated pancreatic tuberculosis: the role of EUS-guided FNA cytology. Gastrointest Endosc. 2012;75(4):900-4.

De Backer AI, Mortelé KJ, Bomans P, De Keulenaer BL, Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol. 2005;184(1):50-4.

Yan CQ, Guo JC, Zhao YP. Diagnosis and management of isolated pancreatic tuberculosis: experience of 13 cases. Chin Med Sci J. 2007;22(3):152-5.

Seufferlein T, Bachet JB, Van Cutsem E, Rougier P. Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23 Suppl 7:vii33-40.

Downloads

Published

2023-11-01

How to Cite

Tri Wicaksana, A. A. F., Bramantono, B., Rusli, M., Arfijanto, M. V., & Hadi, U. (2023). Puzzling Clinical Appearance of a Pancreatic Tuberculosis Case. Acta Medica Indonesiana, 55(3), 315. Retrieved from https://www.actamedindones.org/index.php/ijim/article/view/2046

Issue

Vol. 55 No. 3 (2023): Acta Medica Indonesiana

Section

CASE REPORT

License

Copyright

The authors who publish this journal agree to the following requirements:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)
Privacy Statement

The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.