ISOLATED TUBERCULOSIS OF THE PANCREAS MASQUERADING AS A PANCREATIC MASS

A 65-yr-old woman presented for evaluation of a pancreatic mass, She h ad been suffering from severe constitutional symptoms for 18 months; t hose symptoms included weight loss, increasing fatigue, night sweats, and recurrent fever attacks up to 40 degrees C. Later, bluish subcutan eous nodules developed on her lower limbs, Laboratory tests yielded si gns of chronic inflammation and impaired glucose tolerance with elevat ed serum insulin and glucagon concentrations, Skin biopsy revealed lob ular panniculitis, Ultrasonography and a CT scan demonstrated enlargem ent of the pancreas, and endoscopic retrograde pancreaticography discl osed displacement and stenosis of the main pancreatic duct, The patien t was referred for explorative laparotomy, which was highly suggestive of a malignant pancreatic tumor. However, histological examination of the resected pancreatic and peripancreatic mass revealed tuberculous pancreatitis, This form of isolated tuberculous pancreatitis, associat ed with lobular panniculitis and laboratory features consistent with a tumor of the endocrine pancreas, has not been reported previously, Ac tive tuberculosis should be a leading differential diagnosis in a pati ent with an enlarged pancreas when the usual diagnostic reasoning does not yield conclusive results.