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ARTICLE IN PRESSG ModelDLD-2717; No. of Pages 1

Digestive and Liver Disease xxx (2014) xxx–xxx

Contents lists available at ScienceDirect

Digestive and Liver Disease

jou rna l h om epage: www.elsev ier .com/ locate /d ld

mage of the Month

ancreatic tuberculosis: Look at the kidney!

ishal Sharma, Puneet Chhabra, Surinder Singh Rana ∗, Deepak Kumar Bhasinepartment of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India

Reference

Fig. 1.

A 60 year old male recently diagnosed with diabetes presentedith abdominal pain and loss of weight. Plain roentgenogram of

bdomen showed calcified shrunken right kidney (Fig. 1; arrow)nd contrast enhanced computed tomography revealed bulky headf pancreas with hypodense areas (Fig. 2; black arrow) and denselyalcified right kidney (Fig. 2; white arrow). Positron emissionomography (PET) showed fluorodeoxyglucose avid soft tissueesion in the head of pancreas and multiple peripancreatic and

ediastinal lymph nodes. A possibility of pancreatic cancer wasonsidered but a left putty kidney with multiple lymph nodes

Please cite this article in press as: Sharma V, et al. Pancreathttp://dx.doi.org/10.1016/j.dld.2014.08.043

n the abdomen and mediastinum raised suspicion of tuberculo-is. Endoscopic ultrasound (EUS) showed bulky head of pancreasith peripancreatic and subcarinal lymphadenopathy and EUS

uided fine needle aspiration revealed necrosis and epithelioid

∗ Corresponding author at: Department of Gastroenterology, PGIMER, Chandigarh60012, India. Tel.: +91 172 2749123; fax: +91 172 2744401.

E-mail addresses: drsurinderrana@yahoo.co.in, drsurinderrana@gmail.com (S.S.ana).

[

ttp://dx.doi.org/10.1016/j.dld.2014.08.043590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All

Fig. 2.

granulomas. The stain for acid fast bacilli was positive. Patient wasstarted on anti-tubercular treatment and has gained 10 kg weightover past 2 months with improvement in appetite.

Putty kidney is a result of diffuse dystrophic calcification of kid-ney that has been extensively damaged [1]. It is a very importantsign of end stage renal tuberculosis and may provide clue regardingthe underlying aetiology, especially in patients with multi-organinvolvement [1].

ic tuberculosis: Look at the kidney! Dig Liver Dis (2014),

1] Kumar V, Jha V, Sakhuja V. Putty kidney. Iranian Journal of Kidney Diseases2012;6:255.

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