Tubercular Papillitis of Vater

Tateki Yamane, Takayuki Ishii, Akira Umeda, Shigeharu Takagi, Hitoshi Shimao

Department of Surgery, The International University of Health and Welfare, Shioya Hospital, Yaita, Japan.
Division of Gastroenterology, Department of Internal Medicine, The International University of Health and Welfare, Shioya Hospital, Yaita, Japan.
Division of Neurology, Department of Internal Medicine, The International University of Health and Welfare, Shioya Hospital, Yaita, Japan.
Division of Pulmonology, Department of Internal Medicine, The International University of Health and Welfare, Shioya Hospital, Yaita, Japan.
Sanikukai Family Clinic, Funabashi, Japan.

DOI: 10.4236/ijcm.2012.36086                

Abstract

A middle-aged man with no symptom or history visited our hospital due to duodenal abnormality and fecal occult blood detected by health screening. Upper gastrointestinal endoscopy showed marked enlargement of the papilla of Vater surrounded by nodules, and biopsy disclosed non-caseating granuloma. Colonoscopy yielded findings suggestive of intestinal tuberculosis such as annular ulcers. Examination of the biopsy samples failed to make a diagnosis of tuberculosis, and no pulmonary lesion was found, but whole-blood interferon gamma release assay was positive. The duodenal lesion was also suspected to be tubercular, so antitubercular drugs were administered. As this resulted in the resolution of both lesions, a definite diagnosis of tubercular papillitis of Vater was made. Duodenal tuberculosis is rare, and a localized lesion of the major duodenal papilla is extremely rare. However, this case suggests that tuberculosis must be considered in the differential diagnosis of lesions of the papilla of Vater.

Keywords

Duodenal Tuberticulosis; Papillitis of Vater; Intestinal Tuberculosis

Conflicts of Interest

The authors declare no conflicts of interest.

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