When to suspect:
(1) HIV-infected patient
(2) person from a region where tuberculosis is endemic
(3) miliary tuberculosis
(4) alcoholic with cirrhosis
It is not uncommon that the diagnosis of tuberculosis is not even considered.
Clinical findings:
(1) abdominal pain
(2) persistent fever
(3) sweating
(4) weight loss
(5) variable obstructive jaundice
(6) variable gastrointestinal bleeding
(7) variable ascites
(8) variable reactivity on PPD testing, sometimes being negative
Imaging findings:
(1) pancreatic enlargement
(2) pancreatic mass that may mimic carcinoma or a cystic tumor
(3) compression of the common bile duct if in the head of the pancreas
(4) fistula
(5) lymphadenopathy
(6) peripancreatic fluid collection
(7) splenic vein thrombosis
Laboratory findings:
(1) elevated lipase and/or amylase
(2) elevated total serum bilirubin and liver function tests
(3) positive acid fast smear, culture or PCR in a needle aspirate of a pancreatic lesion
