A 45 year old female patient presented with 2 month history of obstructive jaundice. Her bilirubin was 5.8mg/dl, ALT 68u/l and Alkaline Phosphatase 3800u/l. Ultrasound abdomen showed diffusely enlarged pancreatic head, slightly prominent pancreatic duct, mildly dilated CBD & intrahepatic biliary channels. CT abdomen showed an ill defined hypodense lesion, measuring 3.6x3.7 cm in the pancreatic head with post contrast enhancement. A cholangiogram obtained during ERCP only showed a dilated biliary system with a stricture at lower end of common bile duct. On EUS examination, a mass was detected in pancreatic head measuring 3.1 x 3 cm which was vascularized without clear boundaries. Small sub-centimeter mediastinal lymph nodes were also noted. Fine needle aspiration cytology from pancreatic head and body showed pyogenic abscess where as the lymph node showed reactive changes. Histopathology from pancreatic head and body showed benign mucin secreting glands and epithelial cells where as the lymph node showed tuberculous lymphadenitis. Patient was given a standard 5 drug intensive phase anti tuberculous therapy (ATT) with good clinical improvement. Conclusion: Pancreatic TB can present as obstructive jaundice in TB endemic area. EUS is an optimal tool for establishing diagnosis in such case.
Key words: pancreatic tuberculosis, obstructive jaundice, endoscopic ultrasound
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