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Protean Clinical Features and Diagnostic Dilemmas of Pancreatic Tuberculosis

Abstract Tuberculosis (TB) is a systemic disease with protean manifestations and an important health problem. Approximately 15% of cases involve extrapulmonary sites with pancreatic TB (PTB) being rare. Clinically and radiologically, it may mimic a pancreatic malignancy, thus posing a clinical dilemma. The vague symptomatology and lack of clinical findings make it trickier to diagnose. We present a case series of patients with PTB and their tricky diagnosis and management. Endoscopic ultrasound–guided fine needle aspiration cytology along with various ancillary tests were used for the correct diagnosis. Endoscopic ultrasound–guided fine needle aspiration cytology provided the diagnosis, especially with the help of an expert cytologist experienced in the diagnosis of TB, thereby avoiding unnecessary laparotomy. Response to antituberculous therapy for 6 to 12 months is predictable and complete in these patients. Endoscopic ultrasound–guided fine needle aspiration cytology is the modality of choice for diagnosing PTB. However, patients still need to be followed up carefully for subjective and objective response to therapy to rule out the rare possibility of TB coexisting with malignancy, especially in endemic areas.