Elsevier

Clinical Imaging

Volume 81, January 2022, Pages 114-117
Clinical Imaging

Body Imaging
Pancreatic tuberculosis in an immunocompetent young female mimicking a malignant tumor: A case report and diagnostic radiological investigation

https://doi.org/10.1016/j.clinimag.2021.09.021Get rights and content

Highlights

  • Pancreatic tuberculosis (PTB) can mimick a malignant tumor.

  • PTB is hard to differentiate from other pancreatic diseases by standard MRI.

  • MRI apparent diffusion coefficient values provide valuable insights for diagnostic.

Abstract

Tuberculosis remains the leading cause of infectious disease related death worldwide with extrapulmonary tuberculosis being particularly difficult to diagnose. Here, we report a case of pancreatic tuberculosis (PTB) in an immunocompetent young female, which mimicked a malignant tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration and biopsy (EUS-FNAB). A 19-year-old Japanese female with no prior medical history presented with abdominal epigastralgia and appetite loss lasting 2 months. A solid lobular mass was observed in the pancreatic head with enhanced abdominal computed tomography and magnetic resonance imaging suggested it was a malignant pancreatic tumor. Using EUS-FNAB, granulomas with caseous necrosis and acid-fast bacilli were observed. Polymerase chain reaction results were positive for Mycobacterium tuberculosis but negative for Mycobacterium avium complex. Therefore, the patient was diagnosed with PTB. Her symptoms and radiological findings improved with a standard antituberculosis therapy. PTB is difficult to differentiate from other pancreatic diseases with Magnetic resonance imaging (MRI) patterns of T1, T2 weighted, or diffusion-weighted image (DWI) images. To investigate novel radiological diagnostics for PTB, we focused on MRI apparent diffusion coefficient (ADC) values, which have not been investigated in this context. The present case showed 0.52 × 10−3 mm2/s; additionally, the mean value of other mass-forming pancreatic diseases, such as pancreatic cancer was 1.592 × 10−3 mm2/s (the range: 1.015–3.025 × 10−3 mm2/s). The range does not overlap with the present PTB case or other pancreatic diseases. Therefore, ADC values may be useful as a noninvasive radiological diagnostic method for PTB.

Introduction

Tuberculosis remains the leading cause of death among infectious diseases in adults worldwide, with more than 10 million people suffering each year.1 Pulmonary tuberculosis is the most common type of tuberculosis; however, some cases have extrapulmonary lesions, such as lymphadenitis, pleuritis, and rarely urinary, intestinal tract, or skeletal lesion, which are difficult to diagnose.2 Here, we report a case of pancreatic tuberculosis (PTB) in an immunocompetent young female mimicking a malignant tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration and biopsy (EUS-FNAB).

Section snippets

Case description

A 19-year-old Japanese female with no prior medical history visited other hospitals with abdominal epigastralgia and appetite loss lasting 2 months. As the symptoms did not improve with nizatidine and scopolamine, she was referred to another hospital. Although an upper gastrointestinal endoscopy was normal, a solid mass in the pancreatic head was observed with enhanced abdominal computed tomography; therefore, she was admitted to our hospital for further examination and treatment. Vital signs

Discussion

Tuberculosis remains the leading cause of death from infectious disease among adults worldwide.1 Some cases, especially extrapulmonary tuberculosis, are difficult to diagnose. Notably, extrapulmonary tuberculosis occurs in 18.7% of all tuberculosis patients, and the infection sites are mainly lymphatic (40.4%), pleural (19.8%), bone or joint (11.3%), genitourinary (6.5%), meningeal (5.4%), or peritoneal (4.9%).2 Although some cases with PTB have been reported,3., 4. it is recognized as a rare

Consent for publication

Written informed consent was obtained from the patient for the publication of this report.

Authorship statement

All authors meet the ICMJE authorship criteria.

Declaration of competing interest

None.

Acknowledgment

The authors are grateful to the entire staff of our hospital who gave us valuable advice on the diagnostics and treatments.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

TM and KT drafted the manuscript. SI was responsible for the clinical management and therapy. YN performed the microbiological examination. TM, RS, and KM performed the radiological analysis. MM contributed to the pathological analysis. SK was responsible for the clinical data of mass-forming pancreatic diseases. All authors read and approved the final manuscript.

Ethics approval

The Jikei University School of Medicine Ethics Committee approved this report (No. 33-086 (10698)), June 7, 2021. The procedures were in accordance with the ethical standards of the Helsinki Declaration of the World Medical Association.

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Cited by (0)

Precis: Pancreatic tuberculosis (PTB) can mimick a malignant tumor. PTB is hard to differentiate from other pancreatic diseases by standard MRI. MRI apparent diffusion coefficient values provide valuable insights for diagnostic.

1

These authors contributed equally.

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