A Case of Peripancreatic Tuberculous Lymphadenitis Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration

Overview

Journal Clin J Gastroenterol

Specialty Gastroenterology

Date 2015 Jul 18

PMID 26183512

Citations 3

Authors

Hiroto Furuhashi

Hiroshi Abe

Kai Yoshizawa

Yuki Hirose

Yukiko Miura

Nobuyoshi Seki

Tamihiro Miyazaki

Tomonori Sugita

Yuta Aida

Munenori Itagaki

Haruya Ishiguro

Satoshi Sutoh

Yoshio Aizawa

Affiliations

Soon will be listed here.

Abstract

Tuberculous lymphadenitis is a rare cause of obstructive jaundice. Here, we report the case of a 33-year-old male with obstructive jaundice caused by tuberculous lymphadenitis around the pancreatic head. The patient was born in China and had immigrated to Japan at 12 years of age. He presented with acute abdominal pain and jaundice. Findings from ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography were suggestive of a stenosis of the distal common bile duct caused by multiple low-density masses around the pancreatic head with a contrast-enhanced solid rim. We successfully diagnosed the mass as tuberculous lymphadenitis using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The patient was treated with anti-tuberculous combination chemotherapy for 6 months, and subsequently exhibited clinical improvement. Thus, we found that EUS-FNA was a valuable minimally invasive method for diagnosing masses that cause icterus.

Citing Articles

Left-sided portal hypertension caused by peripancreatic lymph node tuberculosis misdiagnosed as pancreatic cancer: a case report and literature review.

Yu D, Li X, Gong J, Li J, Xie F, Hu J BMC Gastroenterol. 2020; 20(1):276.

PMID: 32811429 PMC: 7436982. DOI: 10.1186/s12876-020-01420-x.

A case of liver hilar tuberculous lymphadenitis complicated by biliary stricture diagnosed by endoscopic ultrasound-guided fine-needle aspiration.

Ando N, Iwata K, Yamazaki K, Shimizu S, Sugihara J, Katayama M Clin J Gastroenterol. 2018; 12(1):57-62.

PMID: 30145769 DOI: 10.1007/s12328-018-0898-5.

An HIV-positive Case of Obstructive Jaundice Caused by Immune Reconstitution Inflammatory Syndrome of Tuberculous Lymphadenitis Successfully Treated with Corticosteroids.

Watanabe N, Sato R, Nagai H, Matsui H, Yamane A, Kawashima M Intern Med. 2017; 56(19):2661-2666.

PMID: 28883243 PMC: 5658536. DOI: 10.2169/internalmedicine.8713-16.

References

Poon R, Lo C, Fan S . Diagnosis and management of biliary obstruction due to periportal tuberculous adenitis. Hepatogastroenterology. 2002; 48(42):1585-7. View

Paquin S, Gariepy G, Lepanto L, Bourdages R, Raymond G, Sahai A . A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc. 2005; 61(4):610-1. DOI: 10.1016/s0016-5107(05)00082-9. View

Sen M, Turan M, Karadayi K, Aslan M, Elagoz S . Peripancreatic tuberculous lymphadenitis mimicking carcinoma: report of a case. Acta Chir Belg. 2004; 104(3):338-40. DOI: 10.1080/00015458.2004.11679568. View

Reisman Y, Gips C, Lavelle S, Wilson J . Clinical presentation of (subclinical) jaundice--the Euricterus project in The Netherlands. United Dutch Hospitals and Euricterus Project Management Group. Hepatogastroenterology. 1996; 43(11):1190-5. View

Micames C, Jowell P, White R, Paulson E, Nelson R, Morse M . Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc. 2003; 58(5):690-5. DOI: 10.1016/s0016-5107(03)02009-1. View

LeBlanc J, Ciaccia D, Al-Assi M, McGrath K, Imperiale T, Tao L . Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc. 2004; 59(4):475-81. DOI: 10.1016/s0016-5107(03)02863-3. View

Shah J, Fraker D, Guerry D, Feldman M, Kochman M . Melanoma seeding of an EUS-guided fine needle track. Gastrointest Endosc. 2004; 59(7):923-4. DOI: 10.1016/s0016-5107(04)00340-2. View

Mert A, Tabak F, Ozaras R, Tahan V, Ozturk R, Aktuglu Y . Tuberculous lymphadenopathy in adults: a review of 35 cases. Acta Chir Belg. 2002; 102(2):118-21. DOI: 10.1080/00015458.2002.11679277. View

Gress F, Gottlieb K, Sherman S, Lehman G . Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer. Ann Intern Med. 2001; 134(6):459-64. DOI: 10.7326/0003-4819-134-6-200103200-00010. View

10.

Wark P, Goldberg H, Ferson M, McKenzie D, Lau E, Rivas K . Mycobacterial lymphadenitis in eastern Sydney. Aust N Z J Med. 1998; 28(4):453-8. DOI: 10.1111/j.1445-5994.1998.tb02080.x. View

11.

Peyre C, Wakim M, Mateo R, Genyk Y, Singh G, Selby R . Unusual cases of jaundice secondary to non-neoplastic bile duct obstruction. Am Surg. 2004; 70(7):620-4. View

12.

Turan M, Sen M, Koyuncu A, Aydin C, Elaldi N, Arici S . Pancreatic pseudotumor due to peripancreatic tuberculous lymphadenitis. Pancreatology. 2002; 2(6):561-4. DOI: 10.1159/000066097. View

13.

Xia F, Poon R, Wang S, Bie P, Huang X, Dong J . Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China. World J Gastroenterol. 2003; 9(6):1361-4. PMC: 4611817. DOI: 10.3748/wjg.v9.i6.1361. View

14.

Doi S, Yasuda I, Iwashita T, Ibuka T, Fukushima H, Araki H . Needle tract implantation on the esophageal wall after EUS-guided FNA of metastatic mediastinal lymphadenopathy. Gastrointest Endosc. 2008; 67(6):988-90. DOI: 10.1016/j.gie.2007.10.025. View

15.

Colovic R, Grubor N, Jesic R, Micev M, Jovanovic T, Colovic N . Tuberculous lymphadenitis as a cause of obstructive jaundice: a case report and literature review. World J Gastroenterol. 2008; 14(19):3098-100. PMC: 2712184. DOI: 10.3748/wjg.14.3098. View

16.

Chong A, Venugopal K, Segarajasingam D, Lisewski D . Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia. Gastrointest Endosc. 2011; 74(4):933-5. DOI: 10.1016/j.gie.2010.10.020. View

17.

Wiersema M, Vilmann P, Giovannini M, Chang K, Wiersema L . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997; 112(4):1087-95. DOI: 10.1016/s0016-5085(97)70164-1. View

18.

Song T, Lee S, Park D, Lee T, Lee S, Seo D . Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis. Gastrointest Endosc. 2009; 69(3 Pt 1):484-91. DOI: 10.1016/j.gie.2008.10.007. View

19.

Fain O, Lortholary O, Djouab M, Amoura I, Babinet P, Beaudreuil J . Lymph node tuberculosis in the suburbs of Paris: 59 cases in adults not infected by the human immunodeficiency virus. Int J Tuberc Lung Dis. 1999; 3(2):162-5. View

20.

Obama K, Kanai M, Taki Y, Nakamoto Y, Takabayashi A . Tuberculous lymphadenitis as a cause of obstructive jaundice: report of a case. Surg Today. 2003; 33(3):229-31. DOI: 10.1007/s005950300051. View