>Cirugía y Cirujanos
>Year 2010, Issue 4
Suárez-Moreno RM, Hernández-Ramírez DA, Madrazo-Navarro M, Salazar-Lozano CR, García-Álvarez KG, Espinoza-Álvarez A
Tuberculosis of the pancreas: an unsuspected cause of abdominal pain and fever
Cir Cir 2010; 78 (4)
PDF: 324.35 Kb.
Background: Tuberculosis is frequently the form of presentation of human immunodeficiency virus (HIV) infection even in patients who have not developed acquired immune deficiency syndrome (AIDS). Nevertheless, pancreatic affection is uncommon. Tuberculosis of the pancreas (TBP) is a clinical rarity and mimics pancreatic carcinoma both clinically and radiologically.
Clinical case: We present the case of a 42-year-old man with a 5-day evolution of moderate abdominal pain in the right lower quadrant and fever and vomiting without diarrhea. The patient had no history of abdominal surgery. CT scan revealed a heterogeneously enhancing, multicystic structure in the pancreatic head. Due to suspicion of malignancy, a pancreatoduodenectomy was performed with pathological result of pancreatic tuberculosis. The patient was discharged on the 10th postoperative day without surgical complications. He died 10 months later of Pneumocystis jirovecii pneumonia. By that time he had a positive serum HIV antibodies test.
Conclusions: TBP diagnosis can be missed or significantly delayed because it is often not suspected prior to laparotomy unless there is evidence of pulmonary tuberculosis. TBP should be considered in the differential diagnosis of a mass in the head of the pancreas. The response to early antituberculosis treatment is very effective.
||Pancreatic tuberculosis, acquired immunodeficiency deficiency syndrome.
Ayala-Hernández I, Martínez-González M, Halabe-Cherem J. Absceso pancreático tuberculoso como manifestación inicial del síndrome de inmunodeficiencia adquirida. Rev Gastroenterol Mex 1998;63:220-223.
Auerbach O. Acute generalized miliary tuberculosis. Am J Pathol 1944;20:121-136.
Brugge W, Mueller P, Misdraji J. A 28-year-old man with abdominal pain, fever and a mass in the region of the pancreas. N Engl J Med 2004;350:1131-1136.
Stambler JB, Klibaner MI, Bliss CM, LaMont JT. Tuberculous abscess of the pancreas. Gastroenterology 1982;83:922-925.
Mourad FH, McLean A, Farthing MJ. Tuberculous pancreatitis: a diagnostic problem. Case report and review of literature. J Clin Gastroenterol 1995;10:237-240.
Varshney S, Johnson CD. Tuberculosis of the pancreas. Postgrad Med J 1995;71:564-566.
Franco-Paredes C, Leonard M, Jurado R, Blumberg HM, Smith RM. Tuberculosis of the pancreas: report of two cases and review of the literature. Am J Med Sci 2002;1:54-58.
Stock KP, Reimann JF, Stadler W, Rosch W. Tuberculosis of the pancreas. Endoscopy 1981;13:178-180.
Watnapa P, Vathanopas V. Tuberculous pancreatic abscess: a rare condition mimicking carcinoma. HPB Surg 1992;5:209-213.
Desai DC, Swaroop VS, Mohandas KM. Tuberculosis of pancreas: report of three cases. Am J Gastroenterol 1991;86:761-763.
Brusko G, Melvin WS, Formkes JJ, Ellison EC. Pancreatic tuberculosis. Am Surg 1995;61:513-515.
Tetzeli JP, Pisegna JR, Barkin JS. Tuberculous pancreatic abscess is a manifestation of AIDS. Am J Gastroenterol 1989;84:581-582.
Eyer-Silva WA, Moraid de Sa CA, Pinto JFC. Gameiro CAM. Pancreatic tuberculosis as a manifestation of infection with the human immunodeficiency virus. Clin Infect Dis 1993;16:332.
Lupatkin H, Brau N, Flomemberg P, Simberkoff MS. Tuberculous abscesses in patients with AIDS. Clin Infect Dis 1992;14:1040-1044.
Berson BD, Mendelson DS, Janus CL. Tuberculous abscesses in patients with AIDS: CT findings. Mt Sinai J Med 1989;56:297-299.
Meinke AK. Pancreatic tuberculous abscess. Conn Med 1989;53:139- 141.
Cho KC, Lucak SL, Delany HM. Morehouse HT. CT appearance in tuberculous pancreatic abscess. J Comput Assist Tomogr 1990;14:152- 154.
Ezratty A, Gumaste V, Rose E, Sachar DB. Pancreatic tuberculosis: a frequently fatal but potentially curable disease. J Clin Gastroenterol 1990;12:74-77.
Cappell MS, Javeed M. Pancreatic abscess due to mycobacterial infection associated with the acquired immunodeficiency syndrome. J Clin Gastroenterol 1990;12:423-429.
Shafer RW, Kim DS, Weiss JP. Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine 1991;70:384- 397.
Radin DR. Intraabdominal Mycobacterium tuberculosis vs Mycobacterium avium-intracellulare infections in patients with AIDS: distinction based on CT findings. AJR. Am J Roentgenol 1991;156:487- 491.
Bricaire F, Marche C, Zoubi D. HIV and the pancreas. Lancet 1988;1:65-66.
Bascunana A, Torrest Tortosa MT, Perez Perez MP. Abscesos abdominals tuberculosos en pacientes con SIDA. Med Clin 1990;95:259-261.
Jaber B, Gleckman R. Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review. Clin Infect Dis 1995;20:890- 894.
Singh D, Singh R, Clarkston WK. Image of the month. Pancreatic tuberculosis in a patient with human immunodeficiency virus: a rare diagnosis. Clin Gastroenterol Hepatol 2009;7:e40-41.
Kumar R, Kapoor D, Singh J, Kumar N. Isolated tuberculosis of the pancreas: a report of two cases and review of the literature. Trop Gastroenterol 2003;24:76-78.
Cheng J, Tadi K, Halpern M, Feurdean M, McNelis J. Pancreatic tuberculosis in a human immunodeficiency virus positive patient: a case report. World J Gastroenterol 2008;14:939-940.
Desmond NM, Kingdon E, Beale TJ. Tuberculous pancreatic abscess: an unusual manifestation of HIV infection. JR Soc Med 1995;88:109P- 110P.
>Cirugía y Cirujanos
>Year 2010, Issue 4