P-HPB-16: Pancreatic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration

Pancreatic tuberculosis is a rare condition even in countries where tuberculosis is endemic. Presentation as a discrete mass may mimic pancreatic neoplasm and therefore warrants thorough investigation. Diagnosis may require histology and culture. We present a case of pancreatic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 22-year-old male was admitted due to 2-month history of epigastric pain, early satiety, and weight loss. Abdominal computed tomography scan revealed a multilocular lesion measuring 6.6 cm × 8.9 cm × 6 cm located at the head of the pancreas. EUS-FNA of the lesion was performed and cytology did not show any malignant cells. Culture for acid-fast bacilli was positive for Mycobacterium tuberculosis susceptible to isoniazid, rifampicin, pyrazinamide, and ethambutol. Antimycobacterial therapy was started and the patient subsequently reported a significant symptom relief. This case illustrates the utility of EUS-FNA as a method for diagnosis of pancreatic tuberculosis. Accurate diagnosis is needed to avoid unnecessary laparotomy. Pancreatic tuberculosis should be included in the differential diagnosis of a pancreatic mass, especially in endemic areas.