[Abdominal tuberculosis: a rare differential diagnosis of pancreatic carcinoma].
METHODS
A 79-year-old local resident, presenting with abdominal pain, sweating and weight loss and suspected of having cancer of the pancreas was referred for diagnosis and treatment. Physical examination was negative except for pain on pressure over the right upper abdomen and the epigastrium.


METHODS
Erythrocyte sedimentation rate was increased; as were the transaminases and cholestasis parameters. Ultrasonography and computed tomography of the abdomen revealed an echo-poor mass with cystic areas in the region of the head of the pancreas, as well as extra- and intrahepatic dilatation of the biliary tract. Endoscopic retrograde cholangiopancreatography failed to demonstrate a ductal pancreatic carcinoma. Biopsies of a macroscopically peculiar-looking duodenal ulcer demonstrated a noncaseous epithelioid granuloma. A fine-needle biopsy was performed for further diagnosis.


METHODS
Histological examination of the needle biopsy revealed a caseous granuloma and acid-fast bacteria. The tuberculin test (GTI) was strongly positive (14-15 mm), indicating tuberculosis of the pancreas and duodenum. Multiple tuberculostatics rapidly improved the patient's symptoms, and the further course was without complications.


CONCLUSIONS
Tuberculosis should be included in the differential diagnosis of consumptive disease with an atypical presentation, especially because treatment could well be curative.
Enders
M
M
Innere Medizin II, Medizinischen Klinik, Universitätskliniken des Saarlandes, Homburg/Saar.
Zuber
M A
MA
Venzke
T
T
Köhler
M
M
Zeitz
M
M
Duchmann
R
R
D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010179:Pancreas / Q000473:pathology; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000188:drug therapy; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000188:drug therapy
D000995:Antitubercular Agents