Demographic characteristics, laboratory features and complications in 346 cases of brucellosis: A retrospective study from Qatar.

Objectives: To study the epidemiology and laboratory findings and outcomes of human brucellosis in the state of Qatar. Methods: A retrospective study involving adult patients with a definitive diagnosis of brucellosis was conducted. Results: Of the 346 patients 299 were males. The mean age was 39.62 years. 120 patients had history of drinking raw milk and 116 had a history of contact with animals. Fever (89.9%) and myalgia (56.6%) were the most common presenting symptoms observed. Raised C-reactive protein level was the most frequent laboratory finding noted. Alanine aminotransferase and aspartate aminotransferase levels were raised to three times the normal in 39.6% and 37% of patients, respectively. Blood culture was positive in 72.8% whereas Brucella immunoglobulin G antibody and immunoglobulin M antibody titer was positive in 72.5% and 73.1% patients, respectively. Approximately 21.4% had focal involvement and osteoarticular (11.6%) involvement was the most frequently observed focal form. Doxycycline with rifampicin or gentamicin was the common regimen received. Relapse was seen in 7.2% patients. Conclusion: Human brucellosis continues to be a serious health issue in Qatar predominantly affecting healthy young adult men resulting in significant morbidity. Preventive measures and community awareness particularly among high-risk groups will help in decreasing the prevalence of the disease and its aftereffects.

Gastroduodenal Tuberculosis Presenting as a Gastric Outlet Obstruction: A Case Report.

Abdominal tuberculosis (TB) can affect any part of the gastrointestinal tract, solid organs, peritoneum, or lymph nodes. The diagnosis of abdominal TB is usually delayed due to a lack of specific clinical signs and symptoms and the mimicking of other intra-abdominal diseases. We present a case of gastroduodenal tuberculosis with peripancreatic lymph node involvement presented as a gastric outlet obstruction that was treated conservatively with anti-tuberculosis medications.

Acute Cardiomyopathy and Delayed Neuropsychiatric Sequelae of Carbon Monoxide Poisoning: A Case Report.

Carbon monoxide (CO) is an odorless and colorless gas that is formed by the combustion of hydrocarbon. CO poisoning is not an uncommon phenomenon that can have serious consequences for morbidity and mortality. The most frequent causes of accidental poisoning include smoke inhalation from fires, malfunctioning heating devices, smoke from motor vehicles in a poorly ventilated or enclosed space, and electrical cable fires. CO has a higher affinity to hemoglobin than oxygen leading to the formation of carboxyhemoglobin. It impairs the oxygen transport and cytochrome chain which, therefore, leads to further cellular and immunological changes. Here, we present a case of CO poisoning resulting in combined cardiac and neuropsychiatric complications.

Association Between Proton Pump Inhibitor Use and Extended-Spectrum Beta-Lactamase Urinary Tract Infection in Adults: A Retrospective Study.

Purpose: To study the association between proton pump inhibitor (PPI) use and the risk of urinary tract infection (UTI) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL). Patients and Methods: A retrospective cross-sectional study was conducted between October 2018 and September 2019. Adults with ESBL-UTIs were compared to adults with UTIs caused by gram-negative bacteria (GNB) and those with UTIs caused by miscellaneous organisms. The association between ESBL infection and PPI use was assessed. Results: A total of 117 of 277 ESBL cases, 229 of 679 non-ESBL GNB controls, and 57 of 144 non-ESBL miscellaneous controls were exposed to PPIs within 3 months prior to admission. The univariate analysis indicated unadjusted odds ratio for PPI exposure with ESBL infection versus the GNB controls was 1.43 (95% CI 1.07-1.90, P = 0.015) while the odds ratio for PPI exposure with ESBL infection versus miscellaneous organisms was 1.10 (95% CI 0.73-1.67, P = 0.633) indicating positive association (PPI exposure increases risk of ESBL infection). Multivariate analysis revealed a positive association between ESBL infection and PPI use versus the GNB controls with an odds ratio of 1.74 (95% CI 0.91-3.31). While Esomeprazole was positively associated with ESBL infection, particularly compared with the miscellaneous group (adjusted OR 1.35, 95% CI 0.47-3.88), Lansoprazole was inversely associated (adjusted OR 0.48, 95% CI 0.18-1.24 and adjusted OR 0.40, 95% CI 0.11-1.41 for ESBL versus GNB controls and ESBL versus miscellaneous organisms, respectively). Conclusion: Exposure to PPIs in the preceding 3 months showed an association with increased risk of ESBL-UTI. While Esomeprazole showed a positive association, Lansoprazole had an inverse association for ESBL-UTI. Restricting the use of PPIs may be beneficial in the fight against antimicrobial resistance.

Venous Thromboembolism Among Hospitalized Patients: Incidence and Adequacy of Thromboprophylaxis - A Retrospective Study.

Purpose: We aimed to determine the incidence of venous thromboembolism among hospitalized patients in Qatar as well as to analyze the adequacy of VTE assessment and prophylaxis in hospitalized patients. Design: Retrospective observational study. Setting: Four hospitals under Hamad Medical Corporation, Qatar. Participants: Patients over the age of 18 who were hospitalized between January 2015 and December 2019 and developed venous thromboembolism during hospitalization or within a month after discharge were included. Results: During the study period, 641,994 individuals were admitted to hospitals. The inclusion criteria were satisfied by 209 of them. The mean age was 51.25 years and 54.5% were males. Hypertension and diabetes mellitus were the most common comorbidities found in the overall group. The incidence of VTE was 32.55 [95% CI 28.4, 37.3] per 100,000 admission per year [0.032%]. The annual incidence was least in 2015 (17.8 per 100,000 admissions) and highest in 2018 (44.4 per 100,000 admissions). Eighty-six subjects had DVT, and 109 had PE, whereas 14 had both. And, 67.5% of the patients developed VTE during admission while, 32.5% developed within 1 month of discharge. Moreover, 22.9% of the patients with PE developed pulmonary embolism after discharge from the hospital. VTE assessment was performed on 64.7% of the patients, and 69.7% received VTE prophylaxis in accordance with guidelines. Conclusion: Although the occurrence of VTE among hospitalized patients in Qatar is low, healthcare providers need additional education and knowledge of VTE assessment and prophylaxis to follow guidelines for all patients at the time of admission. Furthermore, risk assessment for VTE should be done for all patients at the time of discharge to decide on post-discharge prophylaxis so that incidence of VTE after discharge can be minimized. Future studies should focus on patients who developed VTE after discharge from the hospital as well as on various risk factors.

Epidemiology of urinary tract infection in adults caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae - a case-control study from Qatar.

Background: Community-acquired urinary tract infection (UTI) is the most common infection caused by extended-spectrum beta-lactamase (ESBL)-producing organisms. Aim: to estimate the prevalence of ESBL-UTI in adults and to identify potential risk factors that may predispose to ESBL-UTI. Methods: A retrospective study involving adult patients with UTI caused by ESBL-producing organisms was undertaken. Patients with UTI caused by non-ESBL-producing organisms represented the control group. Results: In total, 1100 UTI isolates were included in the study, 277 of which were ESBL positive. The prevalence rate was 25.2%. The mean age of patients was 55.87 years. On univariate analysis, prior history of UTI or ESBL-UTI, invasive urological procedure within preceding 3 months, hospital admission within preceding 3 months, and exposure to antibiotics were found to be significant risk factors for ESBL-UTI. On multi-variate analysis, use of cephalosporins [adjusted odds ratio (OR) 1.61, P=0.048], previous ESBL-UTI (adjusted OR 2.67, P<0.001), and invasive urological procedure in the preceding year (adjusted OR 1.61, P=0.022) were found to be independent risk factors for ESBL-UTI. Conclusions: In Qatar, the prevalence of ESBL-UTI in adults is modest. Recent exposure to antibiotics, previous ESBL-UTI and invasive urological procedures were found to be independent risk factors for ESBL-UTI.

Comparison of demographic, clinical and laboratory characteristics between first and second COVID-19 waves in a secondary care hospital in Qatar: a retrospective study.

OBJECTIVE: To compare the patient profile and outcomes in Qatar during the first and second waves of the COVID-19 pandemic. SETTING: A retrospective observational study was conducted comparing the demographic, clinical and laboratory characteristics of patients with COVID-19 infection admitted to a secondary care hospital, during the first and second waves of the pandemic. PARTICIPANTS: 1039 patients from the first wave and 991 from the second wave who had pneumonia on chest X-ray and had a confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab were included. Patients with a normal chest X-ray and those who had a negative PCR test despite a positive COVID-19 antigen test were excluded. OUTCOME: Length of stay, need for mechanical ventilation, final disposition and mortality were the key outcomes studied RESULTS: Influenza like symptoms (18.5% in the first wave vs 36.1% in the second wave, p 0.001), cough (79.2% vs 87%, p<0.001) and dyspnoea (27.5% vs 38% p<0.001) were more common in the second wave. Second wave patients had significantly higher respiratory rate, lower peripheral oxygen saturation, needed more supplemental oxygen and had higher incidence of pulmonary embolism. More patients received hydroxychloroquine and antibiotics during the first wave and more received steroids, antivirals and interleukin-1 antagonist during the second wave. The second wave had a shorter length of stay (14.58±7.75 vs 12.61±6.16, p<0.001) and more patients were discharged home (22% vs 10%, p<0.001). CONCLUSIONS: Patients who presented during the second wave of COVID-19 pandemic appeared to be more ill clinically and based on their laboratory parameters. They required shorter hospitalisation and were more likely to be discharged home. This could represent greater expertise in handling such patients that was acquired during the first wave as well as use of more appropriate and combination therapies during the second wave.

Gas Under Diaphragm: A Rare Case of Ruptured Liver Abscess With Gas Forming Organism.

Acute abdominal pain with free air under the diaphragm visible on chest/abdomen X-ray (pneumoperitoneum) is a medical emergency. Most of such cases of pneumoperitoneum are attributable to perforated hollow viscus; however, other possibilities like rupture of liver abscess (by a gas-forming organism) also need to be considered. Further imaging like a CT scan might help in the diagnosis and would also obviate the need for laparotomy in some of such cases. We report a case of acute abdominal pain with gas under the diaphragm due to a ruptured liver abscess caused by Klebsiella pneumoniae. The patient was managed successfully with ultrasound-guided percutaneous aspiration and insertion of a drain along with antibiotics and supportive measures, and no laparotomy was performed.

Severe hypothyroidism-induced rhabdomyolysis: A case report.

Hypothyroidism causing rhabdomyolysis is a known but an uncommon entity. Hashimoto's thyroiditis causing rhabdomyolysis in the absence of precipitating factors is even rarer. Here, we report a 42-year-old previously healthy man with hypothyroidism due to Hashimoto's thyroiditis complicated by severe rhabdomyolysis and acute kidney injury in the absence of precipitating factors. The diagnosis was based on his clinical presentation and laboratory investigations, and he was successfully treated with intravenous fluid therapy and oral levothyroxine.

Evaluating Acute Testicular Pain Using Point-of-Care Hand-Held Doppler in the Emergency Department: A Prospective Pilot Study.

Introduction Testicular pain is one of the common conditions in patients visiting the emergency department. The causes of acute testicular pain vary from non-urgent inflammatory conditions like epididymo-orchitis to testicular torsion which is a surgical emergency. Early diagnosis of testicular torsion with early initiation of appropriate surgical intervention helps in salvaging the testes. There is a need for a simple, rapid bedside diagnostic tool for the evaluation and triaging of subjects with acute testicular pain in the emergency department. The aim of this study is to determine whether hand-held Doppler (HHD) examination by the emergency department (ED) physician can safely rule out testicular torsion in a case of acute testicular pain. Materials and Methods A prospective pilot study was conducted in the emergency department of Alkhor Hospital, Hamad Medical Corporation, Qatar. The subjects between 18 to 50 years of age who presented to the ED with testicular pain were included. Subjects with recent trauma to the scrotum, or recent genitourinary surgery and those who had pain for more than 48 hours were excluded. Point-of-care HHD was done by a single ED physician who was blinded for the Doppler study results done by the radiologist. The results of the HHD performed by the ED physician and Doppler study performed by the radiologist were compared and analyzed. Results  Forty-five patients were included in the study. The mean age was 28 years and the mean duration of pain was 20 hours. HHD ruled out testicular torsion in 44 subjects with a specificity of 97.8%. In one subject, HHD was reported as torsion testis which was ruled out by the radiologist. The radiologist Doppler ruled out torsion in all 45 subjects. Conclusion The diagnostic performance of HHD by the ED physicians was almost equal to that of radiologists in ruling out testicular torsion. HHD can be used as a first-line triaging tool by the ED physician to rule out torsion of testis in patients presenting with acute testicular pain. We conclude that patients with testicular pain with a negative HHD for torsion testis can be safely discharged from the emergency department.

Potential Predictors and Prevalence of Helicobacter pylori Infection Among Adult Patients With Dyspepsia: A Retrospective Study From Qatar.

Aim To study the prevalence of Helicobacter pylori (H. pylori) infection among dyspeptic patients of various ethnic origins in Qatar and determine the association between H. pylori infection and various demographic factors and endoscopic findings. Methods A retrospective data review was carried at Alkhor Hospital, Hamad Medical Corporation, Qatar. Adult patients who underwent endoscopy for the evaluation of dyspepsia between January 2011 to December 2017 were included. Patients who underwent endoscopy for reasons other than dyspepsia and those with incomplete data were excluded. Results Of the 638 subjects included, 58.9% were males, and the mean age of the subjects was 42.2 years (range 18-79 years). Epigastric pain (80.6%) was the most common symptom, followed by heartburn (26.2%). Forty point nine percent (40.9%) had a positive Campylobacter-like organism (CLO) test for H. pylori. A higher prevalence of H. pylori infection was observed among subjects between 31-50 years of age (43.6%) and 18-30 years (40.5%), and in Asian (42.2%) and Middle East and North African nationals (MENA) nationals (40%). Among the endoscopic findings, esophagitis (P=0.002) and gastritis (P=0.001) showed a statistically significant correlation with H. pylori positivity. Univariate regression analysis revealed an increased risk for H. pylori infection among all age groups except above 65 years, with an odds ratio (OR) of more than 2 in all the three age groups. Among various ethnicities, patients from Asia and MENA countries showed an increased risk of getting H. pylori infection (OR 1.16, 95% CI; 0.77,1.75 and OR 1.06, 95% CI 0.70,-1.61 respectively). The multivariable logistic regression analysis showed that subjects with endoscopic findings of esophagitis (adjusted OR 1.67, 95%CI 1.19, 2.34; P=0.003), gastritis (adjusted OR 1.79, 95%CI 1.27, 2.57; P=0.001), and duodenal ulcer (adjusted OR 2.41, 95%CI 1.24, 4.70; P=0.010) remained significantly associated with an increased risk of having H. pylori infection. Conclusion The burden of H. pylori infection in patients with dyspepsia undergoing endoscopy is not low in Qatar. Less than 65 years of age, Asian nationals, and being from the MENA region were the demographic predictors for H. pylori infection. The finding of esophagitis, gastritis, and duodenal ulcer on endoscopy were independent endoscopic predictors for having H. pylori infection.

Complicated Brucellosis With Multisystem Involvement: Two Case Reports.

Brucellosis is a zoonotic infection caused by facultative intracellular bacteria of the genus Brucella. The ability of the organism to invade both phagocytic and non-phagocytic cells and survive in the intracellular environment makes brucellosis a systemic infection that can affect various organs of the body. Complications of brucellosis occur when the infection involves one or more focal body sites. Early identification of complications of brucellosis and initiation of appropriate treatment is the key to a better outcome. Here we present two cases of complicated brucellosis, both having multiple body site involvement.

Carbimazole-Induced Jaundice in Thyrotoxicosis: A Case Report.

Carbimazole is a commonly used antithyroid drug in thyrotoxicosis. It is generally well tolerated, and its side effects include allergic skin reactions, gastrointestinal upset, agranulocytosis, and hepatotoxicity. Hepatitis is a rare but serious side effect. Here we report a case of carbimazole-induced hepatitis with severe cholestasis that was managed by switching to propylthiouracil. Most of the literature recommends radioiodine or surgery as the definitive treatment for hyperthyroidism in thionamide-induced hepatitis rather than switching to other thionamide. However, substitution of one thionamide for another can be tried as we did in this case, without any increased risk of hepatotoxicity as the mechanism of liver injury differs in both groups. A previously healthy 30-year-old lady who was diagnosed with thyrotoxicosis one month earlier that was treated with carbimazole 60 mg daily was admitted to the medical ward with yellowish discoloration of sclera, urine, and pruritus of one-week duration. Systemic examination was unremarkable except for icterus. Investigation showed hyperbilirubinemia and elevated liver enzymes. A probable diagnosis of carbimazole-induced cholestatic hepatitis was made and the drug was discontinued. Other causes of hepatitis and cholestasis were excluded. Attempts to arrange radioiodine or treat the patient surgically were not successful. She was continued on propranolol and later started on steroids and propylthiouracil. The patient's liver function tests (LFTs) started improving gradually. On follow-up, LFTs normalized at four weeks and thyroid function tests (TFTs) showed signs of improvement. The patient was followed up for six months after discharge and was doing well clinically on follow-up; her repeat TFT and LFT were completely normal. Carbimazole-induced hepatitis is exceedingly rare; however, it should be considered in patients with jaundice and thyrotoxicosis. Despite reports of cross-reactivity of the two available antithyroid drugs, switching from carbimazole to propylthiouracil and steroid therapy may be an option if other options of definitive therapy could not be arranged or are contraindicated.

Primary Pericardial Synovial Sarcoma: An Extremely Rare Cardiac Neoplasm.

Primary pericardial tumors are an entity that is infrequently encountered and may be a cause of pericardial effusion. Primary synovial sarcomas of the pericardium are even rarer malignant invasive tumors that are a challenge to recognize due to their vague presentation and difficulty in diagnosing non-invasively. Here, we report a case of a 48-year-old gentleman of South Asian descent, who was incidentally found to have pericardial and bilateral pleural effusions and subsequently diagnosed to have primary pericardial synovial sarcoma.

Isolated intramural hematoma of the duodenum following trivial blunt trauma - A case report with review of literature from ED physician's perspective.

Duodenal injuries occurring in isolation following trauma are rare. In the abdomen, blunt trauma usually results in isolated duodenal injuries than penetrating injuries. The signs and symptoms of such injuries are subtle which results in delay in seeking medical consultation and subsequent diagnosis. To diagnose these cases, high index of clinical suspicion and early request for contrast enhanced CT scan of the abdomen is needed. This report explores a case of isolated long segment intra mural hematoma of the duodenum following trivial blunt trauma to the abdomen.

Endoscopic Findings in Patients With Uninvestigated Dyspepsia: A Retrospective Study From Qatar.

Background and objective Dyspepsia is a common complaint encountered in general clinical practice. The prevalence of clinically significant endoscopy findings in dyspeptic subjects of various age groups and ethnicities in Qatar is not well studied. This study aimed to evaluate the prevalence of endoscopic findings in previously uninvestigated patients with dyspepsia. Patients and methods We retrospectively studied subjects older than 18 years of age who underwent endoscopy for dyspeptic complaints from January 2011 to December 2017. Subjects who already had peptic ulcer disease (PUD), those who underwent endoscopy for reasons other than dyspepsia, and those with incomplete data were excluded. Results A total of 824 subjects were reviewed for eligibility and 733 were included for analysis. The mean ±SD age of the study subjects was 42.7 ±13.5 years, and 59.5% of the subjects were male. Epigastric pain was the predominant symptom (79.2%) followed by heartburn (26.1%). Abnormal endoscopic findings were noted in 91.8% of subjects. Gastritis (65.5%) and oesophagitis (33.1%) were the most common findings observed. The overall prevalence of gastric ulcers was 4.6%, and it was higher in subjects who were more than 60 years of age (14.1%, p=0.001). Gastric carcinoma was seen in only four (0.54%) subjects. Conclusion Gastritis was the most common endoscopic finding observed followed by oesophagitis. The most common presenting symptoms were epigastric pain and heartburn. The prevalence of gastric ulcers was significantly high in patients above 60 years of age, and the incidence of gastric carcinoma was low in the study population.

Diagnostic Performance of Point-of-Care Troponin I and Laboratory Troponin T in Patients Presenting to the ED with Chest Pain: A Comparative Study.

BACKGROUND: Chest pain is a common symptom in patients visiting the emergency department (ED). Diagnosing acute coronary syndrome is a challenging task for emergency physicians. Evaluation of chest pain depends on clinical symptoms and signs, ECG, and cardiac enzymes. Here, we aimed to compare the diagnostic performance of the point-of-care troponin I assay with laboratory HsTnT assay in patients presenting to the ED with chest pain. METHODS: A prospective study was done at the ED of Alkhor Hospital, Hamad Medical Corporation, between March 2016 and December 2016. Patients more than 18 years old who presented to the ED with chest pain were enrolled. Patients with renal failure, initial ECG showing ST-elevation MI, or arrhythmias, and hemodynamically unstable patients were excluded. A blood sample was collected at 0 and 3 hours post-admission for POC TnI and laboratory HsTnT assay. The sensitivity, specificity, PPV, NPV, and AUC were determined and compared. RESULTS: Out of 313 patients enrolled, ten were excluded. At 0 hour, the POC TnI assay had a lower sensitivity (72.5% versus 97.5%) and had almost equal specificity (99.24% versus 93.2%) when compared to lab HsTnT assay. At 3 hours post-admission, the sensitivity increased to 95% versus 100%, and specificity was 100% versus 94.3% when compared to lab HsTnT. The POC TnI assay had a higher PPV than HsTnT, whereas both assays showed a high NPV at 0 and 3 hours. CONCLUSION: Although the diagnostic performance of POC TnI was lower than that of Lab HsTnT at 0 hour, at 3 hours post-admission, the diagnostic performance was almost equal to that of HsTnT. Hence we conclude that chest pain in patients with a negative POC TnI at 3 hours post-admission is unlikely to be due to NSTEMI.

Profile of Patients With Tuberculous Pleural Effusion in Qatar: A Retrospective Study.

Introduction Tuberculosis (TB) remains one of the top 10 causes of death globally. Around 1.7 billion people are infected with mycobacterium TB worldwide, and almost 90% of cases each year are found in 30 high TB burden countries. Due to the influx of a large expatriate population mainly from the high TB burden countries, there is an increased number of pulmonary TB as well as tuberculous pleural effusion cases reported in Qatar. Objectives The demographic, clinical, laboratory, and histopathological parameters of patients with tuberculous pleural effusion were assessed. Methods A single-center study was conducted at Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Adults diagnosed to have tuberculous pleural effusion were included, and those with clinical suspicion of tuberculous pleural effusion with positive sputum acid-fast bacillus (AFB) but negative AFB in pleural samples were excluded. Results A total of 106 patients were reviewed, of whom 100 were included for the final analysis, with 86% being men. Majority were from the Asian subcontinent, and the mean age was 33.8 years (SD ± 10.3). Main symptoms in decreasing order were cough (77%), fever (56%), and chest pain (54%). Of the patients, 72% had normal BMI, and rest were above the normal range. Anemia and hypoalbuminemia were found in 36.7% and 89.8% of the patients, respectively. Positive AFB culture was observed in pleural biopsy (79%), pleural fluid (13%), and sputum (16%). Positive AFB by polymerase chain reaction (PCR) was observed in pleural biopsy (57%), pleural fluid (3%), and sputum (2.2%), whereas AFB smear was positive in 2% of pleural biopsy samples. Caseating granuloma was seen in 80% of patients. All the three Light's criteria were met by 30% of the patients whereas 52% had two criteria fulfilled. No association between the number of Light's criteria and AFB yield was observed. Conclusions TPE was more common in healthy young adults. The AFB yield on pleural biopsy, PCR, and culture was significantly higher than that on all other samples. The number of positive Light's criteria did not have any association with positive AFB yield.

Hidden Nematode Causing Recurrent Pancreatitis: A Case Report.

Even though hepatobiliary ascariasis has been found to cause pancreatitis, it is rare in Qatar and other countries in the Middle East. In this report, we present a case of biliary duct ascariasis causing recurrent pancreatitis. A 46-year-old woman from the Philippines presented with recurrent clinical and biochemical features of acute pancreatitis and was found to have hepatobiliary ascariasis. She was successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) and antihelminthic medication. Although hepatobiliary ascariasis as a cause of pancreatitis is rare, it should be considered in patients with recurrent pancreatitis without an obvious cause, especially in those from endemic areas or those who have visited endemic areas.

An Unusual Cause of a Pancreatic Mass: Pancreatic Tuberculosis.

Isolated pancreatic tuberculosis (TB) is an exceedingly rare disease, even in countries with a high burden of TB. We report the case of a 40-year-old gentleman who presented with a two-week history of fever and abdominal pain. Computed tomography of the abdomen showed a large heterogeneous mass arising from the pancreas with peri-pancreatic lymphadenopathy, infiltration of the stomach, and encasement of the celiac vessels-highly suggestive of pancreatic malignancy. Oesophagogastroduodenoscopy with endoscopic ultrasonography was performed, which showed a necrotic area in the body of pancreas. Fine needle aspiration from the necrotic area was positive for Mycobacterium tuberculosis by polymerase chain reaction (PCR) and culture methods. This case demonstrates an unusual presentation of TB with predominant involvement of the pancreas in the absence of pulmonary or systemic involvement. Clinicians need to be aware of this unique presentation of tuberculosis in order to avoid misdiagnosis and institute timely treatment.