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Bir Diyaliz Hastasında Maligniteyi Taklit Eden İzole Pankreas Tüberkülozu

Isolated Pancreatic Tuberculosis Mimicking Malignancy in a Dialysis Patient

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Abstract (2. Language): 
Isolated pancreatic tuberculosis is an extremely rare diagnosis and is often confused with pancreatic malignancy. A 56-yearold male dialysis patient presented with fever, loss of weight abdominal pain, and lack of appetite. The computerized tomography of pancreas demonstrated a nodular lesion, which was regularly limited, with 2.5 cm diameter on neck of pancreas. In histopathological evaluation of the biopsy sample, which was obtained from pancreatic lesion via needle biopsy under ultrasonography guidance, it was observed that granuloma formations consisted of epitheloid histiocytes and areas with caseification necrosis in centre of the some granuloma formations. Also there were the positive findings, which were consistent with the tuberculosis bacillus, in Erlich- Ziehl-Neelsen staining. The patient was diagnosed as pancreatic tuberculosis and started antituberculosis therapy including rifampicin, isoniaside, ethambutol, and pyrazinamide. This treatment had been continued for three months. Thereafter the treatment was continued with only rifampicin and isoniaside for six months. Signs of the disease disappeared completely.
Abstract (Original Language): 
Pankreas tüberkülozu oldukça nadir görülen bir durumdur ve sıklıkla malignitelerle karışabilir. Elli altı yaşındaki bir diyaliz hastası ateş, kilo kaybı, karın ağrısı ve iştahsızlık yakınmalarıyla başvurdu. Bilgisayarlı ince kesit pankreas tomografisinde; pankreasın baş ile gövde bileşkesinde 2.5 cm çaplı sınırları düzgün nodüler bir lezyon izlendi. Ultrasonografi kılavuzluğunda iğne biyopsisi yöntemiyle pankreastaki lezyondan alınan biyopsi örneğinin histopatolojik değerlendirilmesinde; pankreasta epiteloid histiositlerden oluşan granülom alanları ve bazı alanlarda da granülom merkezine uyan bölgelerde kazeifikasyon nekrozu izlendi. Erlich-Ziehl- Neelsen boyama ile pozitif boyanan tüberküloz basillerine ait bulgular izlendi. Pankreas tüberkülozu tanısı kondu ve rifampisin, izoniyazid, etambütol ve pirazinamidden oluşan dörtlü antitüberküloz tedavi başlandı. Üç ay sonra rifampisin ve izoniyazidden oluşan ikili antitüberküloz tedaviye geçildi ve bu tedaviye altı ay daha devam edildi. Bu sürenin sonunda hastalığın bulguları tamamen ortadan kayboldu.

REFERENCES

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