Notice bibliographique
Résumé
Abstract Background Pancreatic TB is a rare clinical presentation which has proved difficult to diagnose. Its symptomatology and imaging characteristics mimic neoplastic findings. Aims We present the case of a previously healthy 58-year-old man, from an endemic area who presented with epigastric pain caused by pancreatic TB. Methods Case report and review of literature Results A previously well 58-year-old male presented to the emergency room with severe epigastric pain, without fevers or significant weight loss. He had immigrated to Canada from the Philippines in 2001. He denied a personal history of TB, however, he did report that his father had received treatment for active TB. An abdominal CT revealed intrahepatic and extrahepatic bile tree dilation with an abrupt transition in the pancreatic head, possible stricture, as well as mucosal thickening of the duodenum at the level of the abrupt narrowing of the dilated common bile duct, concerning for malignancy. Initial laboratory investigations revealed WBC 6.1 x10E9 cells/L, amylase 114 U/L and lipase 59 U/L. Malignancy work up revealed a normal Ca 19-9 at 29.6 kU/L. HIV testing was negative. CT chest revealed bilateral apical fibrotic lesions and smaller lesions throughout the upper and mid-zones bilaterally, suggestive of progressive massive fibrosis. This was in keeping with the patient’s former occupation as a miner. There was no evidence of granulomatous disease. EUS was undertaken and this revealed a mass in the head of the pancreas measuring 29 x 29 mm. The mass was invading into the common bile duct. The pancreatic head mass appeared to be invading into the duodenum, as a necrotic ulcerating lesion was also identified in the second part of the duodenum and this was biopsied. The surgical pathology returned as necrotizing granuloma, however, the tissue could not be tested for TB. The patient underwent a repeat endoscopy which again revealed a fungating and friable mass in the second part of the duodenum with biopsies taken. Pathology revealed mild chronic inflammation. Staining for Acid Fast Bacilli was negative, however, Mycobacterium Tuberculosis Complex was isolated on tissue culture. The patient was diagnosed with pancreatic TB and initiated on pyrazinamide, ethambutol, isoniazid and rifampin. Conclusions Pancreatic involvement by TB is very rare but it has been increasingly reported in both immunocompromised and immunocompetent populations. Symptomatically, pancreatic TB can present with a multitude of non-specific symptoms, including epigastric pain, fever, anorexia, weight loss, or jaundice. In addition, imaging findings of pancreatic TB may mimic malignancy. Our patient, from an endemic area, presented with epigastric pain consistent with the existing literature on pancreatic TB. Isolated pancreatic TB is a rare clinical entity but should be in the list of differential diagnoses in a patient with pancreatic mass especially in the setting of risk factors of TB. Funding Agencies None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».