CLINICAL CASE: Clinical Case-03: Does pancreatic tuberculosis (diagnosed by endoscopic ultrasound) lead to chronic pancreatitis (confirmed by endoscopic ultrasound)?

A 32-year-old female presented with jaundice, fever, and weight loss for 3 months in December 2015. Ultrasound abdomen showed pancreatic head mass with dilated bile duct. Magnetic resonance cholangiopancreatography showed a pancreatic head mass with normal body and tail of pancreas with dilated bile duct. Endoscopic ultrasound-guided fine needle aspiration from pancreatic head mass showed granuloma. The patient was started with antituberculosis treatment (ATT) and underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting. The patient responded to therapy and continued with ATT for 1 year with bile duct stent in situ. The patient now presented with pancreatic type pain and onset of diabetes. Computed tomography scan showed atrophic pancreas with dilated pancreatic duct in tail. EUS showed five features suggestive of chronic pancreatitis. Blood sugar was elevated suggesting diabetes. The patient was started with oral hypoglycemic agent for diabetes. ERCP was carried out and stent removed. ATT was stopped and pancreatic enzymes were started for pain relief. This case demonstrated that pancreatic tuberculosis may lead to development of chronic pancreatitis in a short period (1 year in this case).