AEGiS-14IAC: Tuberculous pancreatic mass as initial manifestations of AIDS.

14th International AIDS Conference


Barcelona, Spain - July 7-12, 2002

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Tuberculous pancreatic mass as initial manifestations of AIDS.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10238)

Wainstein C, Gulotta H, Bava J, Fumagalli J, Troncoso A, Bernardini E
Infectious Diseases Francisco Muniz Hospital, Buenos Aires, Argentina

BACKGROUND: TB of the pancreas in HIV infected patient is very uncommon. It is usually associated with a delay in starting antituberculosis therapy since cultures may take up to 8 weeks.

METHODS: We report two cases of HIV+ patients, who were diagnosed as having a pancreatic mass on CT scans. Patient RM: clinical presentation: unexplained fever, nausea/vomiting, loss of appetite and upper abdominal pain. No familial or social infection contact was identified. Radiographic findings: normal. Tuberculin skin test was negative, CD4 count 55 cells/mm3, viral load: 2,600,000 copies/mm3. Patient ER: clinical findings: unexplained fever for more than 2 months, abdominal pain, weight loss. CD4 count 20cells/mm3. Viral load 48.539 copies/mm3.

RESULTS: In both cases, sonography and abdominal CT identified a large mass of the pancreatic head. The microbiological studies of pancreas specimen obtained by fine needle cytological punch, revealed Mycobacterium tuberculosis, which was sensitive to all drugs tested (isoniazid, rifampin, ethambutol, streptomycin).

CONCLUSION: Both TB and neoplastic diseases cause pancreas nodules in HIV patients. Unfortunately, the entire pancreases TB symptoms in HIV-infected patients are usually non-specifics, prolonged fever and weight loss being the most common ones. These cases show the relevance of suspecting TB in severely immunosuppressed HIV-infected patients with such sign and symptoms. A drastic decreased of CD4 lymphocytes are registered in all cases. TB should be considered in the differential diagnosis of a pancreatic mass especially when associated with epigastric pain or discomfort and weight loss. The definitive diagnosis required aspirate by needle or laparoscopic excisional biopsy of the lesions.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Infections, CD4 Lymphocyte Count, HIV Seropositivity, Tuberculin Test, Isoniazid, Mycobacterium tuberculosis, Pancreas, HumanKWDaegis,acquiredimmunodeficiencysyndrome,hivinfections,cd4lymphocytecount,hivseropositivity,tuberculintest,isoniazid,mycobacteriumtuberculosis,pancreas,human

020707
B10238

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.