Tuberculous pancreatitis and lymphadenitis. [Abdominal] [CT]

20 year old with a history of trisomy 21 and recent travel to Vietnam. Was seen there for nausea, vomiting, and abdominal pain with diagnosis of acute pancreatitis and what looked like lymphoma (but negative biopsy).

Coronal CT [left]: Big retroperitoneal lymph nodes with central cystic change/necrosis (red arrows).

Axial CT [right]: Done at the level of the green line shows a sausage-shaped pancreas compatible with ongoing versus resolving pancreatitis (red arrows).

Repeat EGD/EUS with celiac lymph node biopsy shows caseating granulomatous inflammation with positive culture and PCR for tuberculosis.