Introduction
Abdominal tuberculosis (TB) commonly affects the intestinal tract, lymph
nodes, peritoneum, and solid organs in varying combinations. Up to
two-thirds of patients with abdominal TB have abdominal lymphadenopathy
or peritoneal disease in addition to intestinal involvement. One-third
may have extra-intestinal involvement also (1). Isolated hepatobiliary
or pancreatic and peripancreatic TB is rare, especially when present in
immunocompetent hosts. It’s often occurring in the setting of miliary TB
or widely disseminated disease (2). Pancreatic TB may present as a
pancreatic abscess, acute or chronic pancreatitis, and cystic or solid
pancreatic masses (2)(3). Clinically and radiologically pancreatic TB
closely resembles a pancreatic malignancy. Therefore, most cases of
pancreatic TB have been diagnosed after exploratory laparotomy surgery
for suspected malignancy. However, with the use of improved imaging
techniques computed tomography (CT) or more recently endoscopic
ultrasound-guided fine-needle aspiration (EUS-FNA) and image-guided
interventions preoperative diagnosis of pancreatic masses is now
possible without going for surgery (2). EUS-guided fine-needle
aspiration allows us not only to obtain tissue samples for PCR diagnosis
but also to perform therapeutic aspiration of the abscess (4). Because
of the non-specific clinical presentation, the disease can elude a
diagnosis, but once diagnosed it responds favorably to anti-tuberculous
therapies (ATT). The available literature related to hepatobiliary or
pancreatic tuberculosis is mostly in the form of case reports or series.
Therefore, we reported our experience with this rare form of abdominal
TB, which presented with pancreatic and liver abscesses, finally
diagnosed and confirmed through both radiological images and EUS-FNA.