گزارش بيمار مبتلا به سل ايزوله‌ي پانكراس: گزارش موردي

A patient with isolated pancreatic tuberculosis: case report

زمينه و هدف: سل در كشورهای در حال توسعه شايع است ولی درگيری احشای شكمی به وسيله آن اتفاق ناشايعی است. اكثر موارد سل پانكراس در زمينه سل منتشر (Milliary) بوده و ابتلای ايزوله پانكراس بسيار نادر است. روش بررسی: بيمار زن 52 ساله‌ای بودند كه در زمستان سال 1392 با شكايت درد اپی‌گاستر، كاهش وزن طی سه ماه مراجعه كردند. در بررسی‌های تصويربرداری توده‌ی cm 2×2 در سر پانكراس ديده شد. بيمار تحت لاپاراتومی تشخيصی قرار گرفت. نتيجه‌گيری: توده‌ی نكروزه در سر پانكراس بود. در بررسی فروزن سكشن گرانولوم سل تشخيص داده شد. از اين‌رو بيمار تحت درمان دارويی ضد سل قرار گرفت. در بررسی‌های بعد درمان توده‌ی پانكراس از بين رفت. با در نظر داشتن بيماری سل در توده‌های پانكراس و بررسی بيشتر پيش يا حين عمل می‌توان از تحميل اعمال جراحی پيچيده به بيمار جلوگيری كرد.

Background: Although Tuberculosis (TB) is prevalent in developing countries, visceral TB is rare. Most cases of pancreatic tuberculosis are seen in association with disseminated TB (miliary) but isolated pancreatic infection is very rare. Especially when present in immunocompetent hosts. In clinical and radiological evaluation, pancreatic TB may present as a pancreatic abscess, acute or chronic pancreatitis, and cystic or solid pancreatic masses, so can confused with neoplasm in most cases. Case presentation: In winter of 2013, a 52-year-old woman was admitted to this hospital with epigastric pain. She also mentioned a history of weight loss during previous three months. Liver transaminases and total bilirubin were within normal range. Chest X-ray performed was negative for any cardiopulmonary process, and lung fields were noted to be clear. A purified protein derivative (PPD) skin test for tuberculosis yielded an induration of less than 1 centimeter. An abdominal CT- scan with IV and oral contrast was done. A 2×2 cm mass was seen in the pancreatic head. A diagnostic laparotomy was done. Conclusion: During surgery, a completely necrotic mass was in the pancreatic head. samples were sent for frozen section. The tuberculosis granuloma was diagnosed. Four drug anti-tuberculosis medication was started and continued for six months. Repeat imaging of the abdomen performed 6-months after the initiation of anti-TB therapy revealed complete resolution of the pancreatic mass, and antitubercular therapy was discontinued after a 6-month duration. Pancreatic tuberculosis can present with a variable spectrum of imaging findings. Furthermore, TB should be considered as a cause of any suspicious pancreatic lesion, especially in patients from areas where the infection is endemic.