We report the case of a 38-year-old male patient, residing in Spain for seven years, with no relevant medical history or toxic habits, who had recently traveled to his country of origin.
The patient complained of intermittent abdominal pain refractory to analgesia for four months, associated with isolated episodes of dysthermic sensation, but without jaundice and coluria.
He had no constitutional syndrome, cough, hemoptysis, or any other associated clinic.
Physical examination revealed good general condition, normal cardiopulmonary auscultation and absence of inguinal adenopathy and supraclavicular notch.
There was no oral muguet or mucocutaneous jaundice.
The abdomen was blade and depressible, without pain at the time of examination and without masses or enlargement.
Blood tests were performed in patients with gammaacetic acid transpeptidase (GGT) of 70 UI/l, with normal levels of leukocytes, erythrocyte sedimentation rate (GTT), glutamate.
The antigenic malignant markers (CEA) and hepatitis C antigen (HCV) 19.9 presented normal values, and a negative result was obtained in the serology for HIV, hepatitis B virus (HBV).
Ultrasonography and computed tomography diagnosed a heterogeneous hypocapemic mass with poorly defined borders, 20 x 21.5 x 27 mm in diameter, affecting the pancreatic isthmus and in contact with the hepatic artery with possible bile duct involvement Wirsung.
Locally advanced pancreatic neoplasm was diagnosed.
However, in view of the doubts regarding the nature of the lesion and the purpose of evaluating the suspicion of pancreatic vascular loss, it was decided to perform an abdominal MRI, which confirmed, in addition to the findings described above, a fatty artery.
In order to establish the diagnosis, a radial echoendoscopy was initially performed, which confirmed the presence of a heterogeneous periduodenal mass with ill-defined borders of 2.3 cm in diameter at the level of the bulb and the second wall.
Finally, a linear echoendoscopy and a puncture of the mass with a 25G needle with three biopsies were performed.
The sample was sent for cytology and a necrotizing granulomatous lymphadenitis compatible with tuberculosis was observed.
These results were positive for Mycobacterium tuberculosis, despite Ziehl-Neelsen staining and Lowenstein culture.
The absence of pulmonary and thoracic lymph node involvement was confirmed by chest X-ray and chest CT.
The diagnosis of primary periduodenal lymph node TBC was confirmed.
After six months of anti-tuberculous medical treatment, the patient remained similar (6 months with quadruple therapy: rifampicin, isoniazid, pyrazinamide and isoniazid). At five months, the patient presented complete resolution of symptoms:
