Pancreatic Tuberculosis or Tumor: A Diagnostic Dilemma

Pancreatic tuberculosis is a frequently misdiagnosed illness owing to its ambiguous presentation mimicking pancreatic carcinoma clinically as well as radiologically. Isolated pancreatic tuberculosis is an extremely rare diagnosis and few case reports or series describe this condition. This is a case report of 36 years old man who presented with abdominal pain associated with nausea for a period of one week. Preliminary biochemical analysis revealed mildly increased pancreatic enzymes with raised TLC. On CT scan, a mass lesion arising from head of pancreas with periportal and retroperitoneal lymphadenopathy causing dilatation of common bile duct and main pancreatic duct was seen which was suggestive of malignancy. Due to unavailability of endoscopic ultrasonography and remote location of our center, a decision was made by the surgical team to perform a pancreatic oduodenectomy along with partial gastrectomy, Whipple?s procedure in spite of negative CA 19.9. Histopathological studies on head of pancreas, stomach, duodenum and lymph nodes were performed revealing multiple confluent epithelioid cell granulomas involving whole of pancreas, lymph nodes and pyloric end of stomach. The patient was then started on appropriate anti tubercular therapy and responded well to treatment. With this case report we hope to bring the differential of tuberculosis upwards in a case of pancreatic mass before an extensive surgery needs to take place.