Pancreaticobiliary tuberculosis diagnosed by endoscopic brushings

Isolated pancreaticobiliary involvement with tuberculosis is extremely unusual. Clinical manifestations include abdominal discomfort, weight loss, obstructive jaundice or pancreatitis. Mass/cystic lesions are seen on imaging studies and are often mistaken for pancreatic malignancy. Diagnosis is by demonstration of caseation necrosis or the presence of acid-fast bacilli on Ziehl Neelson staining in the aspirated or biopsied specimen.

A 35-year-old man presented with pain in the upper abdomen of two-month duration associated with significant weight loss. Investigation showed elevated alkaline phosphatase. Imaging studies revealed a mass in the region of the head of the pancreas with dilated intra-hepatic biliary radicles. The diagnosis of pancreaticobiliary tuberculosis was confirmed by cytology from biliary brushing. Biliary brushings taken during endoscopic retrograde cholangiopancreatography have never previously confirmed the diagnosis of pancreaticobiliary tuberculosis.

To the best of our knowledge, this is the first case report where the diagnosis was made on the basis of biliary brushings.