Pancreatic tuberculosis with acquired immunodeficiency syndrome: A case report and systematic review

Table 1 Clinical characteristics, diagnostic studies, investigations yielding definitive diagnosis, preoperative diagnoses and definitive diagnosis of patients with pancreatic tuberculosis and acquired immunodeficiency syndrome

Clinical characteristics	n (%)
Gender[2,5-20,22-28,30-32,34-38]
Male	28/39 (71.8)
Female	11/39 (28.2)
Known HIV-infected cases[2,5-23,25-38]	11/38 (28.9)
Positive tuberculin skin tests[2,5,6,9,12,13,16,29-31,33,34,38]	7/14 (50.0)
Symptoms[2,5-23,25-38]
Abdominal pain	38/40 (95.0)
Fever	36/40 (90.0)
Weight loss	21/40 (52.5)
Anorexia	12/40 (30.0)
Night sweats	10/40 (25.0)
Nausea or vomiting	9/40 (22.5)
Diarrhea	7/40 (17.5)
Dysphagia	2/40 (5.0)
Cough	2/40 (5.0)
Dysuria, polyuria, and confusion	1/40 for each (2.5)
Signs[2,5-23,25-38]
Epigastric mass	8/40 (20.0)
Significant superficial lymphadenopathy	7/40 (17.5)
Hepatomegaly	7/40 (17.5)
Oral thrush	6/40 (15.0)
Jaundice	6/40 (15.0)
Splenomegaly	2/40 (5.0)
Oral hairy leukoplakia, pruritic papular eruption, ascites, and disorientation	1/40 for each (2.5)
Diagnostic studies	n (%)
Evidence of TB on chest X-rays[2,5,6,8-10,12-15,17-20,23-25,27-32,34-37]	10/31 (32.3)
Abnormal CT scans[2,5-10,12-16,19-38]
Pancreatic/peripancreatic mass with or without diffuse pancreatic enlargement	34/36 (94.4)
Only diffuse pancreatic enlargement	1/36 (2.8)
Small nodular lesions	1/36 (2.8)
Topographic lesions of the pancreatic mass from all imaging studies[2,5-10,12,13,15,16,18-25,27,29-38]
Head of the pancreas	31/36 (86.1)
Body of the pancreas	8/36 (22.2)
Neck of the pancreas	3/36 (8.3)
Tail of the pancreas	2/36 (5.6)
Diagnostic clues of a simultaneous duodenal fistula
Abnormal upper gastrointestinal study[13]	1/1 (100.0)
Abnormal gastroscopy[14,17,27,33,38]	2/5 (40.0)
Investigations yielding definitive diagnosis	(n = 40)[2,5-23,25-38] (%)
FNA with AFB staining and/or mycobacterial culturea	23 (57.5)
Laparotomy	14 (35.0)
Therapeutic diagnosis with evidence of miliary TBb	1 (2.5)
Discharge from pancreaticoduodenal fistula	1 (2.5)
Autopsy	1 (2.5)
Preoperative diagnoses	(n = 15)[2,5,7-13,16-17,19,22,25] (%)
Pancreatic mass	4 (26.7)
Pancreatic cancer	3 (20.0)
Pancreatic abscess of unknown pathogen	3 (20.0)
Acute pancreatitis	2 (13.3)
Tuberculous pancreatic abscessc	2 (13.3)
Lymphoma or retroperitoneal tumor	1 (6.7)
Definitive diagnosis	(n = 40)[2,5-23,25-38] (%)
Tuberculous pancreatic abscess without duodenal fistula	26 (65.0)
Tuberculous pancreatic abscess with duodenal fistula	2 (5.0)
Acute tuberculous pancreatitis without duodenal fistula	2 (5.0)
Acute tuberculous pancreatitis with duodenal fistula	1 (2.5)
Focal acute tuberculous pancreatitis with chronic pancreatitis	1 (2.5)
Pancreatic TB	8 (20.0)

TB: Tuberculosis; AIDS: Acquired Immunodeficiency Syndrome; HIV: Human Immunodeficiency Virus; CT: Computed tomography.

^aOne was performed from the left supraclavicular lymph node instead of the pancreatic mass, and one patient underwent both fine needle aspiration and laparotomy due to clinical deterioration.

^bNo histopathological specimens.

^cDiagnosis was based on a computed tomography scan only in one patient.