Infection Prevention and Control

Statement of the Problem: Tuberculosis is an ubuiqitous organism that attacks all organ tissues of its host. Abdominal TB accounts for about 5-12% of patients with tuberculosis and is most common in developing countries. Autopsy studies have shown that the pancreas is affected by about 2.1-4.7% of those with miliary tuberculosis. Pancreatic tuberculosis is a rare condition that can present mimicking signs and symptoms of pancreatic malignancy and in abdominal imaging as pancreatic mass. The purpose of this study is to report a rare case of Pancreatic Tuberculosis in an immunocompetent Filipino, Male.

Methodology & Theoretical Orientation: A literature search and review was done to extract information about Pancreatic Tuberculosis’ prevalence and incidence, diagnostic approach and treatment approaches considering both international and local guidelines.

Findings: Pancreatic tuberculosis is a rare condition that can present mimicking signs and symptoms of pancreatic malignancy and in abdominal imaging as pancreatic mass. It occurs in the setting of miliary tuberculosis, most frequently in immunocompromised patients, very rarely in immunocompetent. Pancreatic tuberculosis was first reported in 1944 by Auerbach et. al. His study of 1656 autopsies revealed 14 cases with pancreatic involvement but none with isolated pancreatic tuberculosis.6 Reported cases of Pancreatic tuberculosis from 1966 to 2004 in a MEDLINE search of English language articles around 116 cases of pancreatic tuberculosis were identified. From 2005 up to 2014, based on PUBMED search using the MeSH terms “Tuberculosis” and “Pancreas” including literature from English and other languages, there were 49 case reports and 11 case series which include about 164 patients identified. From 2015 until 2018, using the same search engine, there were 5 case reports and 1 case series(5 cases). Based on Google Scholar search, there were 6 cases of pancreatic tuberculosis reported and published.

Conclusion & Significance: Pancreatic tuberculosis is a rare infection most especially in an immunocompetent host. It must be considered in patient presenting to have signs and symptoms of pancreatic malignancy and with radiographic findings of pancreatic mass. It is must be entertained in patients living in areas where Tuberculosis infection is endemic. The treatment of Pancreatic tuberculosis is straightforward and follows treatment protocol for extra-pulmonary tuberculosis infection. It is therefore necessary to confirm diagnosis histologically because response to therapy is predictable and complete with full compliance to regimen.