Obstructive jaundice in AIDS: diagnosis of biliary tuberculosis by ERCP

Probst, Andreas; Schmidbaur, W.; Jechart, G.; Hammond, Angela; Zentner, Jochen; Niculescu, Eugenia; Messmann, Helmut

doi:10.1016/s0016-5107(04)01535-4

Cited by 10 publications

(9 citation statements)

References 11 publications

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“…Four mechanisms have been described: TB of the pancreas itself may cause pseudoneoplastic obstructive jaundice [1][2][3][4][5][6][7][8][9][10] ; it may be secondary to TB lymphadenitis causing compression and inflammation of the lymph nodes and the CBD [6,[11][12][13][14][15][16][17][18][19] , as in our case, with caseation of the lymph node causing fistulation into the CBD; biliary TB itself may lead to single or multiple strictures, mimicking cholangiocarcinoma [20][21][22][23][24][25] ; and TB can create a retroperitoneal mass leading to biliary tree obstruction [26] .…”

Section: Discussionmentioning

confidence: 99%

“…US or CT-guided percutaneous fine needle aspiration (FNA) of the enlarged lymph nodes may be useful [7] , but is often not definitive [21] . Cytology of CBD aspirate, however, obtained by ERCP, may be confirmatory in the presence of the acid-fast bacillus (Mycobacterium tuberculosis); alternatively PCR of the aspirate may be diagnostic [19] . However, in the case of a periportal lymphadenopathy causing obstructive jaundice, as in our patient, these FNA tests are only positive if a fistula exists between the TB lymph node and the CBD, allowing bacilli to pass into the CBD [19] .…”

Section: Discussionmentioning

confidence: 99%

“…Cytology of CBD aspirate, however, obtained by ERCP, may be confirmatory in the presence of the acid-fast bacillus (Mycobacterium tuberculosis); alternatively PCR of the aspirate may be diagnostic [19] . However, in the case of a periportal lymphadenopathy causing obstructive jaundice, as in our patient, these FNA tests are only positive if a fistula exists between the TB lymph node and the CBD, allowing bacilli to pass into the CBD [19] . Other potential diagnostic methods include obtaining tissue specimens by laparoscopy [17] or endoscopic ultrasound with FNA [27] .…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Colović¹,

Grubor²,

Jesic³

et al. 2008

WJG

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Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum.A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed t u b e rc u l o u s l y m p h a d e n i t i s . A f t e r a n u n e ve n t fu l postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Colović¹,

Grubor²,

Jesic³

et al. 2008

WJG

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show abstract

“…Ultrasonography or CT-guided percutaneous fine needle aspiration (FNA) of the enlarged lymph nodes may be useful [12], but is often not definitive [32]. Cytology of CBD aspirate obtained by ERCP may be confirmatory in the presence of the acid-fast bacillus ( Mycobacterium tuberculosis ); alternatively PCR of the aspirate may be diagnostic [24]. In the case of a periportal lymphadenopathy causing obstructive jaundice, FNA tests are only positive if a fistula exists between the TB lymph node and the CBD, allowing bacilli to pass into the CBD [24].…”

mentioning

confidence: 99%

“…Cytology of CBD aspirate obtained by ERCP may be confirmatory in the presence of the acid-fast bacillus ( Mycobacterium tuberculosis ); alternatively PCR of the aspirate may be diagnostic [24]. In the case of a periportal lymphadenopathy causing obstructive jaundice, FNA tests are only positive if a fistula exists between the TB lymph node and the CBD, allowing bacilli to pass into the CBD [24]. Other potential diagnostic methods include obtaining tissue specimens by laparoscopy [22] or endoscopic ultrasound with FNA [38].…”

mentioning

confidence: 99%

Letter to the Editor Pancreatobiliary and peripancreatobiliary tuberculosis: a rare cause of obstructive jaundice

Shen

Liu

2013

aoms

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Case 3-2006

Schapiro¹,

Maher²,

Misdraji³

2006

N Engl J Med

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398 From the Gastrointestinal Unit (R.H.S.) and the Departments of Radiology (M.M.M.) and Pathology (J.M.), Massachusetts General Hospital; and the Departments of Medicine (R.H.S.), Radiology (M.M.M.) and Pathology (J.M.), Harvard Medical School. N Engl J Med 2006;354:398-406. Pr e sen tat ion of C a seA 63-year-old woman was admitted to the hospital for evaluation of a pancreatic mass.Four months before admission, the patient noticed dysuria and dark urine. The results of urinalysis showed 3+ bilirubin and 2+ occult blood and were otherwise normal. A urinary tract infection was diagnosed, and levofloxacin was prescribed. A urine culture subsequently showed no growth of bacteria. Five days after the urinalysis, she went to a local hospital emergency department, where she said that she had had dark urine, pruritus, and intermittent epigastric pain for the preceding 10 days; a weight loss of 5 kg during the past 3 months; and lightening of the color of her stool and a small purple area on her right arm for the past several days. The patient had not had fever, chills, nausea, vomiting, or diarrhea. Abdominal computed tomography (CT) revealed dilatation of the intrahepatic and extrahepatic ducts and enlargement of the pancreatic head. She was transferred to this hospital and admitted.The vital signs were normal. On examination, the patient appeared well and was alert and oriented but jaundiced. The sclerae were icteric, and there was an ecchymosis (2 cm in diameter) on her right thigh; the remainder of the physical examination was normal. The levels of electrolytes, calcium, phosphorus, magnesium, and serum lipids; the results of renal-function studies; and the white-cell, differential, and platelet counts were normal. The results of other laboratory tests are shown in Table 1. A chest radiograph showed two small ill-defined opacities at both lung apexes. Abdominal and pelvic CT scanning on the second hospital day, performed after the administration of oral and intravenous contrast material, revealed dilated intrahepatic and extrahepatic bile ducts; a periportal lymph node that was 7 mm in diameter; a periportal mass, 3.1 cm by 3.6 cm; a complex cystic mass, 2.9 cm by 2.4 cm, in the pancreatic head; another complex cystic mass, 2.7 cm by 1.4 cm, adjacent to the pancreatic tail; and a low-density splenic lesion.Abdominal ultrasonography on the next day confirmed the presence of dilated intrahepatic and extrahepatic bile ducts and a complex cystic mass in the pancreatic head. She had a normal gallbladder. Endoscopic upper-abdominal ultrasonography revealed no abnormalities in the esophagus, stomach, or duodenum. There was a round, thick-walled cystic mass in the pancreatic head, 2.9 cm by 2.4 cm, that abutted

show abstract

Obstructive jaundice in AIDS: diagnosis of biliary tuberculosis by ERCP

Cited by 10 publications

References 11 publications

Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

Letter to the Editor Pancreatobiliary and peripancreatobiliary tuberculosis: a rare cause of obstructive jaundice

Case 3-2006

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