title: [Primary pancreatic tuberculosis in an immunocompetent patient: first case report in Spain].
abstract: Primary pancreatic tuberculosis (PPTB) is an extremely rare entity defined by an isolated pancreatic lesion with microbiological confirmation, in the absence of previously identified tuberculosis (TB) and involvement of any other organ. We report the case of a 47-year-old man referred for abdominal pain and weight loss, in whom several imaging techniques revealed a solid mass in the head of the pancreas. CT-guided fine-needle aspiration cytology was consistent with necrotic granuloma. Intradermic tuberculin reaction was positive, but acid fast bacilli staining was negative in repeat cytology. No additional evidence of TB was found after exhaustive diagnostic work-up. Exploratory laparotomy was proposed for a definitive diagnosis, but cultures grew Mycobacterium tuberculosis at 50 days. The pancreatic lesion disappeared after 4 months of antitubercular therapy. This is the first case report of PPTB in an immunocompetent person in Spain. A high index of suspicion and accurate samples for microbiology are mandatory to avoid unnecessary surgical procedures.
authors.affiliation: Servicio de Medicina Interna, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: Paloma
authors.initials: P
authors.lastname: Barquilla-Cordero
authors.forename: Manuela
authors.initials: M
authors.lastname: Chiquero-Palomo
authors.forename: Elisa
authors.initials: E
authors.lastname: Martín-Noguerol
authors.forename: Nazaret
authors.initials: N
authors.lastname: Pacheco-Gómez
authors.forename: Gema
authors.initials: G
authors.lastname: Vinagre-Rodríguez
authors.forename: Sergio L
authors.initials: SL
authors.lastname: Moyano-Calvente
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010195:Pancreatitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014375:Tuberculoma / Q000175:diagnosis / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents