Pancreatic tuberculosis-abdominal tuberculosis presenting as pancreatic abscesses and colonic perforation

Pancreatic Tuberculosis-A Condition That Mimics Pancreatic Cancer

Tuberculosis is a disease with serious consequences in terms of morbidity and mortality. Pancreatic localization is very rare and is mostly encountered in patients with immunosuppressive disorders. A 59-year-old woman with arterial hypertension, grade 2 obesity, and a history of cholecystectomy, was admitted for fever (38.5 °C), jaundice, and marked physical asthenia. The blood tests showed severe metabolic acidosis, with partial respiratory compensation, mild microcytic normochromic anemia, inflammatory syndrome, procalcitonin value ten times the upper limit of normal, nitrogen retention syndrome, hypoalbuminemia, hypertriglyceridemia, hypercholesterolemia, and moderate hyponatremia. The electrocardiogram, chest X-ray, and abdominal ultrasound did not show any significant pathological changes. Contrast-enhanced computed tomography raised the suspicion of acute-on-chronic pancreatitis and subsequent evaluation by magnetic resonance imaging raised the suspicion of a pancreatic tumor. Pancreatic fine needle biopsy under echoendoscopic guidance revealed purulent material, which was sent for cytological and bacteriological examination. The Ziehl-Neelsen stain showed acid-alcoholic resistant bacilli, while bacterial cultures were positive for gentamicin and tigecycline-sensitive Klebsiella. The diagnosis of pancreatic tuberculosis was established. Pancreatic tuberculosis is a very rare condition that often mimics pancreatic cancer. The peculiarity of the case is the appearance of pancreatic tuberculosis in an immunocompetent woman and the association with Klebsiella infection.

Pancreatic Mass: Include Tuberculosis in the Differential Diagnosis

Although abdominal tuberculosis (TB) is quite prevalent in endemic regions, involvement of the pancreas is considerably rare. We describe a case of pancreatic TB presenting as a pancreatic mass in a patient with abdominal pain and jaundice. Due to the similar presentation, it can easily be misinterpreted as a pancreatic neoplasm. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can help confirm the diagnosis in such cases by providing histopathological evidence of Mycobacterium tuberculosis infection. The patient made a remarkable recovery post anti-tuberculous therapy (ATT) initiation. This exceptional response of pancreatic TB to conservative management makes it imperative that the condition be diagnosed promptly to avoid any futile surgical interventions and associated complications. This can only be achieved if clinicians are aware of the diagnostic possibility of pancreatic TB presenting as a mass in the pancreas.

Primary pancreatic tuberculosis mimicking pancreatic body cancer. A case report and review of the literature

Isolated pancreatic tuberculosis (PT) is an extremely rare disease, with non-specific clinical characteristics, making the diagnosis often challenging with pancreatic cancers.

Here we report a case of a 36-year-old female, who was admitted to our hospital after suffering from a 3-month history of epigastric abdominal pain, night sweats and weight loss. The physical examination was normal. The radiological findings revealed the presence of a pancreatic mass and multiple abdominal lymphadenopathy, suggestive of malignancy. The initial differential diagnosis suspected was pancreatic tuberculosis. Tuberculosis skin test was performed and was highly positive (>22 mm). Computed tomography (CT)-guided biopsy of peripancreatic lymph node was carried out and the histopathological exam confirmed the diagnosis of PT. Therefore, anti-tuberculous therapy was initiated, leading to clinical and radiological improvement.

The diagnosis of PT is rare and can sometimes be misleading. It should be considered when a pancreatic mass is observed, especially in endemic countries, to ovoid unnecessary interventions.

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Isolated pancreatic tuberculosis is an extremely rare disease, with non-specific clinical characteristics.

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Clinical presentation and radiological findings of a pancreatic mass may be suggestive of malignancy.

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Preoperative microbiological or/and histological diagnosis should be made to avoid the patient unnecessary surgical procedures.

Biomedical potential of clay nanotube formulations and their toxicity assessment

Introduction: Halloysite clay nanotubes (HNTs) are a naturally abundant and biocompatible aluminosilicate material with a structure able to encapsulate 10-20% of drugs. These features are attractive toward the clinical application in controlled drug delivery, tissue engineering and regenerative medicine. Areas covered: We describe the application of HNTs as a viable method for clinical purposes, particularly developing formulations for prophylaxis, diagnosis and therapeutics, having a special attention to these nanotubes bio-safety. HNTs may be used for pharmaceuticals, biopharmaceuticals, wound healing, bone regeneration, dental repair, hair surface engineering and biomimetic applications. Expert opinion: HNTs are a versatile, safe and biocompatible nanomaterial used for drug encapsulation for numerous clinical applications. The studies here reviewed confirm the HNTs biocompatibility, describing their low toxicity. Further developments will be made regarding the long-term efficacy of halloysite-based treatments in humans, concentrating mostly on topical applications.

Pancreatic tuberculosis

Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.

Pancreatic Tuberculosis

Tuberculosis of the pancreas is extremely rare and in most of the cases mimics pancreatic carcinoma. There are a number of case reports on pancreatic tuberculosis with various different presentations, but only a few case series have been published, and most of our knowledge about this disease comes from individual case reports. Patients of pancreatic tuberculosis may remain asymptomatic initially and manifest as an abscess or a mass involving local lymph nodes and usually present with non-specific features. Pancreatic tuberculosis may present with a wide range of imaging findings. It is difficult to diagnose tuberculosis of pancreas on imaging studies as they may present with masses, cystic lesions or abscesses and mass lesions in most of the cases mimic pancreatic carcinoma. As it is a rare entity, it cannot be recommended but suggested that pancreatic tuberculosis should be considered in cases with a large space occupying lesions associated with necrotic peripancreatic lymph nodes and constitutional symptoms. Ultrasonography/computed tomography/endosonography-guided biopsy is the recommended diagnostic technique. Most patients achieve complete cure with standard antituberculous therapy. The aims of this study are to review clinical presentation, diagnostic studies, and management of pancreatic tuberculosis and to present our experience of 5 cases of pancreatic tuberculosis.

Imaging of tuberculosis of the abdominal viscera: beyond the intestines

There is an increasing incidence of both intra- and extra-thoracic manifestations of tuberculosis, in part due to the AIDS epidemic. Isolated tubercular involvement of the solid abdominal viscera is relatively unusual. Cross-sectional imaging with ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) plays an important role in the diagnosis and post treatment follow-up of tuberculosis. Specific imaging features of tuberculosis are frequently related to caseous necrosis, which is the hallmark of this disease. However, depending on the type of solid organ involvement, tubercular lesions can mimic a variety of neoplastic and nonneoplastic conditions. Often, cross-sectional imaging alone is insufficient in reaching a conclusive diagnosis, and image-guided tissue sampling is needed. In this article, we review the pathology and cross-sectional imaging features of tubercular involvement of solid abdominopelvic organs with a special emphasis on appropriate differential diagnoses.

Isolated pancreatic tuberculosis mimicking malignancy in an immunocompetent host

Despite the high prevalence of tuberculosis (TB) worldwide, pancreatic TB is rare. When present, pancreatic TB is frequently associated with miliary TB, often in immunocompromised hosts. Pancreatic TB may present as a pancreatic abscess, acute or chronic pancreatitis, and cystic or solid pancreatic masses. We present a case of an immunocompetent patient who presented with two discrete pancreatic masses and was subsequently diagnosed with isolated pancreatic TB. This case suggests that clinicians should have a heightened suspicion of pancreatic TB when faced with discrete pancreatic lesions, especially in patients from areas where the infection is endemic. Such recognition may lead to appropriate diagnostic testing, and possible resolution of pancreatic lesions with antituberculin therapy.

Coexistence of pancreatic carcinoma and pancreatic tuberculosis: case report

Pancreatic tuberculosis (TB) is extremely rare and mimics pancreatic carcinoma both clinically and radiologically. This paper discusses the occurrence of 2 heterogeneous masses located in the head and tail of the pancreas in an adult male. In this patient, laparotomy was performed because of the high suspicion of pancreatic carcinoma. Intraoperative fine needle aspiration biopsy revealed the coexistence of pancreatic carcinoma with pancreatic TB, and a combined resection of the distal pancreas and spleen was successfully performed. Following surgery, the patient received standard chemotherapy for TB. At 7-month follow-up, computed tomography showed resolution of the mass in the pancreatic head. Clinicians must maintain a high index of suspicion for pancreatic TB in patients with pancreatic masses. The coexistence of malignancy and TB should be considered when patients present with multiple pancreatic masses.

Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Isolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient’s occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient’s initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards.