Tuberculous Pancreatic and Liver Abscesses Presenting as Obstructive Jaundice in an Immunocompetent Patient

Isolated hepatobiliary, pancreatic, and peripancreatic tuberculosis (TB) is an extremely rare disease, particularly in immunocompetent individuals. To the best of our knowledge, the presentation of combined pancreatic and liver abscesses is a particularly uncommon presentation among the reported cases in the literature. This presents a significant challenge in clinical diagnosis. In this report, we discuss the case of a 24-year-old Nepalese man who presented with epigastric pain and jaundice. Further, tuberculous pancreatic and liver abscesses were detected by abdominal CT and MRI, which were later confirmed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with pus smear and polymerase chain reaction (PCR) test. These tests were positive for acid-fast bacilli (Mycobacterium tuberculosis). The patient responded well to anti-tubercular therapy (ATT). As the clinical presentation is often unclear and radiological imaging may be misleading, physicians should have a high index of suspicion for TB, especially if the patient is young and belongs to an area highly endemic for TB.

Automated summary

Isolated hepatobiliary, pancreatic, and peripancreatic tuberculosis is rare, with combined pancreatic and liver abscesses being even more uncommon. Physicians should have a high index of suspicion for TB, especially in young patients from highly endemic areas.