[Tuberculous pancreatic abscess as initial manifestation of acquired immunodeficiency syndrome (AIDS)]

Tuberculosis is frequently the form of presentation of HIV infection, even in patients who have not developed AIDS. Nevertheless, pancreatic affection is rare, and focal pancreatic affection is even rarer.

We present the case of a 49 years old man with antecedents of 25 heterosexual partners and exploratory laparotomy three years before because of an hepatic lesion during which he was multitransfunded. He had a one year history of fever, diaphoresis and abdominal pain, in whom ultrasonography detected an image compatible with pancreatic abscess, so he went through laparotomy for drainage; biopsy reported tuberculosis. He persisted with fever and abdominal pain, and a computed tomography scan demonstrated persistent pancreatic abscess. The determination of HIV antibodies was positive, and the CD4 count in 110/mm3. Antituberculous therapy was started and eight weeks later, the computed tomography showed improvement; also, he had clinical improvement. After a two-years follow up, he remains asymptomatic, only with antiretroviral therapy.

Pancreatic tuberculosis is an infrequent complication of this infection. It is considered the result of the dissemination of the infection from near lymphatic nodes. When needle aspiration of a pancreatic abscess is made, it is necessary to effect a culture in order to diagnose tuberculosis. The recommended treatment comprises a four antifimic scheme for 72 doses followed by a triple intermittent scheme for 60 more doses.