A CASE OF ABDOMINAL TUBERCULOUS LYMPHADENOPATHY WHICH PRESENTED DIFFICULTY IN DIAGNOSIS

We experienced a case of abdominal tuberculous lymphadenopathy which was difficult to be distinguished from metastatic disease and malignant lymphoma with various radiographic modalities and its clinical course. A 31-year-old man was seen at the hospital because of fever and cough. Chest X-ray revealed pleural effusion and abdominal ultrasography showed a tumor near the pancreas head. Pleural effusion was diagnosed as tuberculous pleuritis and treated by isoniazid, rifanpicin and streptomycin. From the clinical course, the tumor near the pancreas head was suspected of relating to abdominal tuberculous lymphadenopathy, but no definite diagnosis could be attained by abdominal CT, endoscopic retrograde cholangiopancretogram, and abdominal angiogram. Moreover, since no change or decrease in size of the tumor was observed with the tuberculochemotherapy, we were left to examine a possibility of a malignant disease and proceeded to perform an exploratory laparatomy. We admitted the difficulty to establish the differential diagnosis of Abdominal lymphadenopathy.