Title : The chameleon effect: A case of isolated pancreatic tuberculosis mimicking pancreatic cancer in young adult male with jaundice and hyperglycemia
Abstract:
Introduction: Pancreatic Tuberculosis is considered a rare extrapulmonary source of Tuberculosis even on highly prevalent countries. The diagnosis can be challenging since the signs and symptoms can mimic pancreatic cancer. With the patient’s consent, this case report will emphasize the need to include pancreatic tuberculosis as a differential for pancreatic mass and highlight the hyperglycemic state that this disease can induce.
Case Presentation: We report a case of a 20-year-old male who was admitted due to history of painless jaundice for two months, associated with anorexia and weight loss. He presented with generalized jaundice, night sweats with episodes of hyperglycemia and fever. Double bypass surgery was done with histologic findings of caseous granuloma and Langhan’s type giant cell. The patient was treated with anti-Koch’s medications and with noticeable improvement after a month of treatment. Patient had no recurrence of jaundice and sugar level was controlled. PT can exhibit a variety of non-specific clinical manifestations, however hyperglycemia as a presenting symptom is still under studied. Although, tuberculosis itself can cause a rise in blood levels, this presentation may mimic other endocrine tumors that may be challenging. Once the diagnosis is made, PT management is based on Tuberculosis chemotherapy (streptomycin, rifampicin, isoniazid, pyrazinamide and ethambutol) and generally recommended for intervals 6 months and 12 months.
Conclusion: Solitary pancreatic tuberculosis is a rare disease that requires Suspicious index for diagnosis. And, although is a rare condition, should be considered as a differential diagnosis in patients with pancreatic lesions. Clinical and radiological presentations findings of a pancreatic mass may indicate malignancy. Therefore, vigorous efforts must be made to obtain preoperative microbiological and / or histological examinations.
