Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis |
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Authors: | Soichi Itaba Shigetaka Yoshinaga Kazuhiko Nakamura Takahiro Mizutani Kuniomi Honda Ryoichi Takayanagi Kinya Yamada |
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Institution: | (1) Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan;(2) Department of Gastroenterology, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan |
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Abstract: | The percentage of patients with atypical extrapulmonary forms of tuberculosis has been increasing. Among extrapulmonary tuberculosis
cases, tuberculosis of the pancreas and peripancreatic lymph nodes is a rare clinical entity. Here, we present a case of peripancreatic
tuberculous lymphadenitis diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) both cytologically and
microbiologically. A 23-year-old man had a 1-week history of epigastralgia and low-grade fever. Subsequently, he was found
to have an abnormality on abdominal ultrasound. A computed tomography scan of the abdomen showed a solitary mass consisting
of multiple cystic components with rim enhancement in the peripancreatic portion contiguous to the gall bladder. Endoscopic
ultrasound-guided fine-needle aspiration was performed to confirm the diagnosis. The cytological examination revealed epithelioid
cells with caseous necrosis, indicating tuberculosis. The aspirated fluid was positive by polymerase chain reaction (PCR)
analysis and culture for Mycobacterium tuberculosis. Antituberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide was started based on the PCR and cytology
results, and a good response to the treatment was noted. Endoscopic ultrasound-guided fine-needle aspiration cytology with
PCR analysis is very useful for the diagnosis of peripancreatic tuberculosis. |
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Keywords: | endoscopic ultrasound tuberculous lymphadenitis fine-needle aspiration pancreas |
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