A Case of Obstructive Jaundice Caused by Paradoxical Reaction during Antituberculous Chemotherapy for Abdominal Tuberculosis

Lee, Yun Jung; Jung, Sung Hee; Hyun, Woo Jin; Kim, Sae Hee; Lee, Hyang Ie; Yang, Hyeon Woong; Kim, Anna; Woo, Seung Kyoon

doi:10.5009/gnl.2009.3.4.338

Cited by 14 publications

(18 citation statements)

References 20 publications

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“…In the past decade, there have been several case reports demonstrating that biliary obstruction can be treated without surgery, based on the preoperative biopsy results (19,22,23,34,35). EUS-FNAB is known to be quite useful in the diagnosis of pancreatic lesions (36).…”

Section: Discussionmentioning

confidence: 99%

Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy

et al. 2016

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A 57-year-old man with a history of tuberculosis (TB) was found to have a pancreatic head mass, accompanied by stenosis of the common bile duct. Due to the inherent difficulty in differentiating pancreatic carcinoma from an inflammatory mass, endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) was thus performed. The pathological findings confirmed granuloma with caseous necrosis, and the results of the QuantiFERON TB2G test were positive. Accordingly, the patient was diagnosed with peripancreatic TB and thereafter was successfully treated with anti-TB therapy. Based on the findings of this case, we conclude that EUS-FNAB is a useful modality for the diagnosis of pancreatic TB.

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Section: Discussionmentioning

confidence: 99%

Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy

et al. 2016

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“…Paradoxical reactions are seen in up to 25% of patients1 with tuberculosis after the initiation of antitubercular therapy, and are characterised by clinical deterioration or radiological worsening of pre-existing tuberculosis, or the development of new lesions 2. Typically these reactions occur following an initial phase of response to therapy.…”

Section: Discussionmentioning

confidence: 99%

Tuberculous mediastinal abscess as a paradoxical reaction in an immunocompetent individual

Naha

Vivek²,

Ramachandran

et al. 2012

Case Reports

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A 22-year-old man, diagnosed 7 weeks before with pulmonary tuberculosis and started on antitubercular therapy, presented with non-exertional retrosternal chest pain since the past week. He was diagnosed on the strength of thoracic radiograms and CT imaging to have a mediastinal abscess, which was percutaneously drained. He was continued on the same regimen of drugs. Analysis of the fluid obtained was suggestive of tuberculous aetiology. Steroids were not required.

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“…60 Few cases with paradoxical response with worsening of liver function tests needing biliary drainage have been reported. 1,61 Therefore, the total duration of therapy may be decided on basis of resolution of imaging findings in these patients. Some reports have indicated that patients respond as well with 6 months of ATT, but the mode of follow-up was not mentioned in the report.…”

Section: Treatment Of Pancreatic Tuberculosismentioning

confidence: 99%

Pancreatic tuberculosis

Sharma

Rana

Kumar

et al. 2016

J of Gastro and Hepatol

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Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.

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A Case of Obstructive Jaundice Caused by Paradoxical Reaction during Antituberculous Chemotherapy for Abdominal Tuberculosis

Cited by 14 publications

References 20 publications

Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy

Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy

Tuberculous mediastinal abscess as a paradoxical reaction in an immunocompetent individual

Pancreatic tuberculosis

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