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Title : A 36 year-old male w/ fever and abdominal discomfort
Date : May 16, 2010
Contributed by

Jin Seo Lee, MD
Kangdong Sacred Heart Hospital, Seoul, Korea

Patient History
Age/Sex A 36-year old man
Chief complaint Fever and abdominal discomfort
Present illness

A 36-year old male patient admitted to our hospital with a 7-day history of fever and abdominal discomfort. He had general weakness for a month. Initial laboratory finding reveals that he had positive HIV antibody test. His CD4 count was 53.

Past medical history

HBs Ag(+)

Physical examination

Mild epigastric tenderness/ no rebound tenderness

Initial laboratory findings

8500(N 82.7%, L 9.2% M 7.1%) Amylase 33 lipase 7 normal rage

Radiologic findings

 
Question - ID Case of the Week ( May 16, 2010 )
What is most likely diagnosis and causative microorganism?
 
Correct Answer

Tuberculosis of pancreas

 
Review

 

Despite the increased incidence of tuberculosis related to HIV infection, Tuberculosis of pancreas is a rare entity. The true incidence of pancreatic tuberculosis is not known and a study of 71 AIDS patients reported that pancreas is affected by tuberculosis in 7% of patients with disseminated abdominal tuberculosis(Am J Roentgenol. 1991;156:487-491). Rare occurrence of pancreatic tuberculosis has been postulated to be due to the antibacterial pancreatic factors such as pancreatic enzymes. More than 50% of the cases reported in world literature are less than 30 years of age. Varied clinical presentations have been reported. They range from vague abdominal pain to relatively non specific symptoms such as nausea, fatigue, weight loss, fever, chills and sweating(Am J Gatroenterol. 1989;84:581-582). Rarely, massive gastro-intestinal bleeding (Br J Surg 1986;73:373) and obstructive jaundice(Am J Gatroenterol. 1999;94:2534-2536) have been reported. A large spectrum of imaging findig is observed and most frequent finding is intrapancreatic collections. Nonspecific focal enlargement, mass simulating carcinoma, diffuse enlargement and small nodules have been reported also (J Comput Assist Tomogr 2009;33:136-141). Endoscopic ultrasound or CT-guided fine-needle aspiration biopsy (FNAB) is recommended for diagnosis. The prognosis is good with anti-tuberculosis treatment.   

 


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