Tuberculous mesenteric lymphadenitis mimicking pancreatic carcinoma

Tuberculous mesenteric lymphadenitis is a rare clinical entity and non-surgical diagnosis of this condition remains a challenge. A 38-year-old Indian woman presented with a six-week history of epigastric pain, low-grade fever and anorexia. Upper endoscopy showed a gastric ulcer of the posterior wall of the stomach. On CT scan there was a 8 cm abdominal mass involving the pancreatic body and tail and the endoscopic ultrasonography was also compatible with a cystic pancreatic tumor which had eroded into the stomach. An exploratory laparotomy was performed and the diagnosis of tuberculous mesenteric lymphadenitis was confirmed by bacteriological and histological examinations. Medical therapy was started after surgery. At 18 months she is asymptomatic and abdominal CT scan is normal. Tuberculosis of mesenteric lymph nodes usually raises serious diagnostic problems. A high grade of suspicion is necessary in order to perform a pre-operative diagnosis.