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Revista Española de Enfermedades Digestivas
versión impresa ISSN 1130-0108
Rev. esp. enferm. dig. vol.110 no.7 Madrid jul. 2018
https://dx.doi.org/10.17235/reed.2018.5527/2018
SCIENTIFIC LETTERS
A study of a pancreatic mass: not all is what it seems
1Servicio de Aparato Digestivo. Hospital Universitario La Paz. Madrid, España
Key words: Acute cholangitis; Endoultrasonography; Pancreatic tuberculosis
Dear Editor,
A 48-year-old Ecuatorian male with no previous medical history was admitted to hospital due to acute cholangitis and wasting syndrome of a three-week duration. An abdominal ultrasound and a subsequent abdominal computed tomography (CT) identified a hypoattenuating nodule with a cyst-like appearance in the pancreatic head. The differential diagnosis was either an adenocarcinoma with a necrotic component or a cystic neoplasm. Thus, an endoultrasonography with fine needle aspiration (FNA) was performed (Fig. 1), which revealed an inflammatory granulomatous process with necrosis, giant cells, reactive plasmocytosis and neovascularization. After antibiotic therapy, the cholangitis was resolved and the laboratory tests normalized. However, the patient started to present a persistent fever, neurological and urological symptoms. The patient was finally diagnosed with disseminated tuberculosis (TB) with pancreatic involvement after a complete study with a mycobacterial culture in different media.
Discussion
Pancreatic tuberculosis is a very uncommon condition that usually occurs in context of disseminated TB 1,2. An infection of pancreas can result from hematogenous or lymphatic spread or by reactivation of a previously latent form 3. Diagnosis is a challenge as the symptoms can present as acute or chronic pancreatitis, pancreatic abscess, obstructive jaundice or an isolated pancreatic mass mimicking a neoplasm, as in this case 1. Furthermore, there are no pathognomonic findings on imaging; therefore, pathological and/or microbiological confirmation is required 4. In cases of a pancreatic mass and an unexplained fever, TB is a possibility that should be considered in order to start targeted therapy as soon as possible.
Bibliografía
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2. Barquilla-Cordero P, Chiquero-Palomo M, Martín-Noguerol E, et al. Primary pancreatic tuberculosis in an immunocompetent patient: first case report in Spain. Gastroenterol Hepatol 2010;33:582-5. DOI: 10.1016/j.gastrohep.2010.06.002 [ Links ]
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4. Zacharia GS, Antony R, Kolassery S, et al. Isolated pancreatic tuberculosis masquerading as pancreatic cancer. Gastroenterol Rep (Oxf) 2014;2:154-7. DOI: 10.1093/gastro/gou017 [ Links ]