Two cases of pancreatic tuberculosis in nonimmunocompromised patients -: A diagnostic challenge and a rare cause of portal hypertension
Two cases of pancreatic tuberculosis in nonimmunocompromised patients -: A diagnostic challenge and a rare cause of portal hypertension
复制标题
DOI：
10.1159/000049451
复制
发表时间：
2002-01-01
期刊：
影响因子：
3.6
通讯作者：
Rünzi, M
中科院分区：
文献类型：
--
作者：
Schneider, A;von Birgelen, C;Rünzi, M
胰腺结核是非常罕见的，特别是在免疫功能正常的患者，并代表了诊断的挑战。本文报告2例胰腺结核的CT表现。在第一个病例中，剖腹探查术显示肉芽肿性炎症，提示结核病。胰尾培养涂片检测结核分支杆菌呈阳性，患者对抗结核药物反应良好。在第二个病例中，细针穿刺发现结核病。本病例是胰腺结核门脉高压症的独特病例。抗结核药物治疗几乎没有改善，然后患者失访。由于怀疑癌症，患者在另一家医院接受了剖腹手术。排除胰腺炎，切除化脓坏死胰腺。患者最终在未使用任何抗结核药物的情况下好转，并保持良好状态。两名患者的艾滋病毒检测结果均为阴性。我们总结了诊断困境的病因、临床表现、诊断和治疗，这在临床实践中应予以考虑。版权所有（C）2002 S. Karger AG、巴塞尔和IAP。
Pancreatic tuberculosis is very rare, especially in immunocompetent patients, and represents a diagnostic challenge. We describe 2 cases of pancreatic tuberculosis mimicking carcinoma on CT scan. In the first case, explorative laparotomy revealed granulomatous inflammation suggestive of tuberculosis. Cultured smears from the pancreatic tail tested positive for Mycobacterium tuberculosis, and the patient responded well to antituberculous medication. In the second case, fine needle aspirate revealed tuberculosis. This case is unique with regard to development of portal hypertension in pancreatic tuberculosis. Antituberculous medication achieved little improvement, then the patient was lost to follow-up. In suspicion of carcinoma the patient underwent laparotomy in another hospital. Malignancy was excluded, and a purulent necrotic pancreas was resected. The patient finally improved without any antituberculous medication and remains well. Both patients were tested HIV-negative. We summarize the etiology, clinical presentation, diagnosis and treatment of a diagnostic dilemma, which should be considered in clinical practice. Copyright (C) 2002 S. Karger AG, Basel and IAP.