Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Ali Acar 1 , İlker Sücüllü 2 , Orhan Baylan 3 , Ali Filiz 2 , Hüsrev Diktaş 1 , Mert Kıvanc 4 , Oral Öncül 1 , and Levent Görenek 1
  • 1 Department of Infectious Disease and Clinical Microbiology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, 34668, Istanbul, Turkey
  • 2 Department of General Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, 34668, Istanbul, Turkey
  • 3 Department of Medical Microbiology, Gulhane Military Medical Academy Haydarpasa Training Hospital, Uskudar-Istanbul, 34668, Istanbul, Turkey
  • 4 Acibadem Hospital, 34457, Istanbul, Turkey


Isolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient’s occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient’s initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards.

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  • [1] Leder R.A., Low V.H., Tuberculosis of the abdomen, Radiol. Clin. North. Am., 1995, 33, 691–705

  • [2] Sharma S.K, Mohan A., Extrapulmonary tuberculosis, Indian. J. Med. Res., 2004, 120, 6–53

  • [3] Woodfield J.C., Windsor J.A.., Godfrey C.C., Orr D.A.., Officer N.M., Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review, ANZ. J. Surg., 2004, 74, 368–71

  • [4] Cho S.B., Pancreatic tuberculosis presenting with pancreatic cystic tumor: a case report and review of the literature, Korean. J. Gastroenterol., 2009, 53, 324–8

  • [5] Xia F., Poon R.T., Wang S.G., Bie P., Huang X.Q., Dong J.H., Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China, World. J. Gastroenterol., 2003, 9, 1361–4

  • [6] Singh D.K., Haider A., Tatke M., Kumar P., Mishra P.K., Primary pancreatic tuberculosis masquerading as a pancreatic tumor leading to Whipple’s pancreaticoduodenectomy. A case report and review of the literature, JOP., 2009, 10, 451–6

  • [7] Bhansali S.K., Abdominal tuberculosis. Experiences with 300 cases, Am. J. Gastroenterol., 1977, 67, 324–37

  • [8] Auerbach O., Acute Generalized Miliary Tuberculosis, Am. J. Pathol., 1944, 20, 121–36

  • [9] Kaushik N., Schoedel K., McGrath K., Isolated pancreatic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report, JOP., 2006, 7, 205–10

  • [10] Rolny P., Falk A., Olofsson J., Obstructive jaundice due to isolated tuberculosis of the pancreas: endoscopic treatment instead of surgery? Endoscopy., 2006, 38, 90–2

  • [11] Fan S.T., Yan K.W., Lau W.Y., Wong K.K., Tuberculosis of the pancreas: a rare cause of massive gastrointestinal bleeding, Br. J. Surg., 1986, 73, 373

  • [12] Lal R., Mishra B., Dogra V., Mandal A., Tubercular pancreatic abscess: A case report, Indian. J. Med. Microbiol., 2003, 21, 61–2

  • [13] Veerabadran P., Sasnur P., Subramanian S., Marappagounder S., Pancreatic tuberculosisabdominal tuberculosis presenting as pancreatic abscesses and colonic perforation, World. J. Gastroenterol., 2007, 13478–9

  • [14] Pandita K.K., Sarla., Dogra S., Isolated pancreatic tuberculosis, Indian. J. Med. Microbiol., 2009, 27, 259–60

  • [15] Jenney A.W., Pickles R.W., Hellard M.E., Spelman D.W., Fuller A.J., Spicer W.J., Tuberculosis pancreatic abscess in an HIV negative patient: case report and review, Scand. J. Infect. Dis., 1998, 30, 99–104

  • [16] Suri R., Gupta S., Gupta S.K., Singh K., Suri S., Ultrasound guided fine needle aspiration cytology in abdominal tuberculosis, Br. J. Radiol., 1998, 71, 723–7

  • [17] Mantur B.G., Amarnath S.K., Shinde R.S., Review of clinical and laboratory features of human brucellosis. Indian. J. Med. Microbiol., 2007, 25, 188–202

  • [18] Belo A.C., Grabowski E.W., Zhang C., Longworth D.L., Desilets D.J., Case of chronic pancreatic brucellosis presenting as hemosuccus pancreaticus, JOP., 2007, 8, 429–32

  • [19] Papaioannides D., Korantzopoulos P., Sinapidis D., Charalabopoulos K., Akritidis N., Acute pancreatitis associated with brucellosis, JOP., 2006, 7, 62–5


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