Pancreatic tuberculosis revealed by a mass with neoplastic appearance: a case report.

Abstract

Introduction. Pancreatic tuberculosis is an extremely rare form of extrapulmonary tuberculosis. This condition can be challenging to diagnose due to its rarity, nonspecific symptoms and radiological features that may mimic a neoplastic origin. Case report. A 46-year-old immunocompetent patient with no past history of tuberculosis exposure presented with spontaneously resolving jaundice over the past month, accompanied by nonspecific fever episodes and general fatigue with no other associated digestive symptoms. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a poorly defined, partially necrotic mass in the pancreatic head with heterogeneous hypodensity and enhancement after contrast injection. Additionally, there were nodal and hilar macro-nodal lesions with necrotic appearances, as well as peripancreatic lymphadenopathy. The patient was scheduled for an endoscopic ultrasound (EUS) examination, which revealed the presence of a heterogeneous lesion with areas of necrosis in the posterosuperior aspect of the head and isthmus of the pancreas, accompanied by perilesional and coeliac lymphadenopathies with necrotic centres. EUS-guided tissue sampling allowed the diagnosis of pancreatic tuberculosis, with both histological examination and GeneXpert MTB/RIF testing rapidly positive for Mycobacterium tuberculosis, followed by culture on solid Loewenstein-Jensen medium. The patient responded well to antitubercular chemotherapy. Conclusion. Pancreatic tuberculosis, though rare, should be considered in cases of pancreatic masses, especially in endemic regions. Tissue samples with necrosis should be tested for M. tuberculosis using GeneXpert and Loewenstein-Jensen culture. This work highlights the GeneXpert MTB/RIF test as highly sensitive, specific and fast, making it ideal for diagnosing extrapulmonary tuberculosis, particularly when smear results are negative.