Tuberculous Lymphadenitis as a Cause of Obstructive Jaundice: Report of a Case

Abstract.

We report a rare case of obstructive jaundice caused by enlarged tuberculous lymph nodes compressing the common bile duct in the retropancreatic region, mimicking pancreatic cancer. A 32-year-old man was admitted to our hospital with a 1-month of history of jaundice. An abdominal computed tomography (CT) scan showed a tumor in the pancreatic head, but an endoscopic retrograde cholangiopancreatogram (ERCP) showed a normal pancreatic duct system. Positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG-PET) revealed a hot spot only in the pancreatic head. Under a presumptive diagnosis of malignancy, a laparotomy was performed and an intraoperative biopsy specimen revealed epithelioid granuloma with caseous necrosis, which led us to suspect tuberculous lymphadenitis. This diagnosis was confirmed by culture, and antituberculous therapy was commenced postoperatively. The patient has not suffered any further episodes of obstructive jaundice. This case report demonstrates that positive FDG-PET results should be interpreted carefully when diagnosing tumors of the pancreatic head.