Pulmonary tuberculosis with venous thromboembolism as an unusual presentation of occult pancreatic cancer: a case report

Abstract

Pancreatic cancer is usually diagnosed at a relatively advanced stage due to the heterogeneous and nonspecific clinical presentation. Thus, it poses a significant diagnostic challenge as the disease is usually clinically silent at the early stage. Typically, by the time of diagnosis, pancreatic cancer is associated with an extremely poor survival rate. The clinical features depend on the size and location of the tumour as well as its metastases. The suspicion of pancreatic cancer thus noted in retrospect and hence suggesting a missed opportunity for early detection. To our best knowledge, there have been no reported cases of pulmonary tuberculosis (PTB) with venous thromboembolism as the initial presentation of pancreatic cancer. The exact pathogenesis regarding venous thromboembolism with tuberculosis in pancreatic cancer is still unknown and debatable. Herein, we report an interesting case of smear positive PTB with venous thromboembolism leading to the elusive diagnosis of advanced pancreatic cancer. We discuss on possible novel hypotheses for the mechanism of venous thromboembolism in pancreatic cancer as well as association between tuberculosis and pancreatic cancer. His condition deteriorated even on standard treatment for PTB and thromboembolism that prompt further investigation for malignancy. He missed the golden period for treatment for the pancreatic cancer and subsequently succumbed to the illness. Early investigation for malignancy may be appropriate for tuberculosis patients who develop venous thromboembolism especially those clinically deterioration on standard treatment.