title: [Tuberculosis of the pancreas: an unsuspected cause of abdominal pain and fever].
abstract: BACKGROUND
  Tuberculosis is frequently the form of presentation of human immunodeficiency virus (HIV) infection even in patients who have not developed acquired immune deficiency syndrome (AIDS). Nevertheless, pancreatic affection is uncommon. Tuberculosis of the pancreas (TBP) is a clinical rarity and mimics pancreatic carcinoma both clinically and radiologically.
  
  
  METHODS
  We present the case of a 42-year-old man with a 5-day evolution of moderate abdominal pain in the right lower quadrant and fever and vomiting without diarrhea. The patient had no history of abdominal surgery. CT scan revealed a heterogeneously enhancing, multicystic structure in the pancreatic head. Due to suspicion of malignancy, a pancreatoduodenectomy was performed with pathological result of pancreatic tuberculosis. The patient was discharged on the 10th postoperative day without surgical complications. He died 10 months later of Pneumocystis jirovecii pneumonia. By that time he had a positive serum HIV antibodies test.
  
  
  CONCLUSIONS
  TBP diagnosis can be missed or significantly delayed because it is often not suspected prior to laparotomy unless there is evidence of pulmonary tuberculosis. TBP should be considered in the differential diagnosis of a mass in the head of the pancreas. The response to early antituberculosis treatment is very effective.
authors.affiliation: Dirección Médica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D. F., Mexico. heram@hotmail.com
authors.forename: Roberto Manuel
authors.initials: RM
authors.lastname: Suárez-Moreno
authors.forename: Daniel Alejandro
authors.initials: DA
authors.lastname: Hernández-Ramírez
authors.forename: Mario
authors.initials: M
authors.lastname: Madrazo-Navarro
authors.forename: Carlos Rafael
authors.initials: CR
authors.lastname: Salazar-Lozano
authors.forename: Karla Gisela
authors.initials: KG
authors.lastname: García-Álvarez
authors.forename: Arturo
authors.initials: A
authors.lastname: Espinoza-Álvarez
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005334:Fever / Q000209:etiology*; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D011020:Pneumonia, Pneumocystis / Q000150:complications; D014383:Tuberculosis, Endocrine / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery
chemical_list: D000995:Antitubercular Agents