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Disseminated tuberculosis following invasive procedures for peripancreatic lymph node tuberculosis with portal vein obstruction: a case report

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Abstract

Peripancreatic tuberculous lymphadenopathy can mimic pancreatic cancer on imaging. There have only a few reports on varices from portal vein obstruction due to abdominal tuberculous lymphadenopathy. Iatrogenic disseminated tuberculosis is also rare. Herein, we present a rare case of peripancreatic tuberculous lymphadenopathy with ruptured duodenal varices due to portal vein obstruction. The patient presented to our hospital with hematemesis. Computed tomography revealed a peripancreatic mass. Duodenal varices rupture from portal vein obstruction due to pancreatic cancer were initially suspected. The patient underwent portal vein stenting for portal vein obstruction and endoscopic ultrasound-guided fine-needle aspiration for diagnosis, which revealed granulomas indicative of tuberculosis. The patient was discharged once because fine-needle aspiration did not lead to a definitive diagnosis of tuberculosis. Subsequently, he developed disseminated tuberculosis. Peripancreatic tuberculous lymphadenopathy can cause ectopic varices with portal vein obstruction. Tuberculosis should also be included in the differential diagnosis in the case of portal vein obstruction, to facilitate early treatment and avoid unnecessary surgery. Furthermore, fine-needle aspiration or portal vein stenting for tuberculous lesions can cause disseminated tuberculosis. Since a diagnosis might not be made until after several fine-needle aspirations have been conducted, careful follow-up is necessary after the procedure for such lesions.

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Funding

The authors received no financial support for the publication of this article.

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Authors and Affiliations

  1. Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan

    Aya Kato & Yasuaki Motomura

  2. Department of General Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan

    Takahisa Mashiba

  3. Department of Infectious Disease, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan

    Yoshinori Tateishi & Rentaro Oda

  4. Department of Interventional Radiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan

    Hiraku Funakoshi

  5. Department of Rheumatology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan

    Keiichi Iwanami

Authors
  1. Aya Kato
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  2. Takahisa Mashiba
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  3. Yoshinori Tateishi
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  4. Rentaro Oda
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  5. Hiraku Funakoshi
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  6. Keiichi Iwanami
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  7. Yasuaki Motomura
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Contributions

AK, TM, YT, RO, HF, KI, and YM: contribute to taking care of the patient, planning, reporting, conception, acquisition of data, analysis and interpretation of data, and discussing them.

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Correspondence to Aya Kato.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient for inclusion in the study.

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Kato, A., Mashiba, T., Tateishi, Y. et al. Disseminated tuberculosis following invasive procedures for peripancreatic lymph node tuberculosis with portal vein obstruction: a case report. Clin J Gastroenterol 15, 673–679 (2022). https://doi.org/10.1007/s12328-022-01624-6

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  • DOI: https://doi.org/10.1007/s12328-022-01624-6

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