{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:58Z","timestamp":1783491538903,"version":"3.55.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extrapulmonary tuberculosis can imitate malignancy and systemic autoimmune disease. Concurrent duodenal tuberculosis with probable biliary involvement is exceptionally uncommon and may create a high-stakes pancreatobiliary cancer mimic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 71-year-old Han Chinese woman with primary Sj\u00f6gren\u2019s syndrome and type 2 diabetes, and no recent immunosuppressive therapy, presented with polyarthralgia, intermittent fever, abdominal discomfort, anorexia, constipation, and weight loss. Laboratory testing showed systemic inflammation and a cholestatic enzyme pattern, whereas bilirubin and tumor markers remained normal. Magnetic resonance cholangiopancreatography revealed diffuse bile-duct wall thickening with severe distal common bile duct stenosis, and positron emission tomography-computed tomography showed hypermetabolic duodenal thickening with multiple fluorodeoxyglucose-avid lymph nodes. The tuberculin skin test measured 15 x 12\u00a0mm at 48 and 72 hours, and interferon-gamma release assay was positive (T-N &amp;gt;10.00 IU\/mL). Upper endoscopy demonstrated a duodenal ulcer with fistula formation, and biopsy showed ulceration, granulomatous inflammation, and one acid-fast bacillus on staining. Supraclavicular lymph-node aspiration revealed lymphocytes and multinucleated giant cells without malignant cells. Duodenal tuberculosis with nodal disease and probable, non-biopsy-proven biliary involvement was diagnosed. After discharge, she received specialist-supervised antituberculosis therapy including isoniazid 0.3\u00a0g daily, rifampicin 0.45\u00a0g daily, and levofloxacin 0.5\u00a0g daily; by January 2022, treatment had continued for more than 3 months. The initial phase structure and total treatment duration could not be reliably ascertained. Symptoms, inflammatory and cholestatic markers, endoscopic ulceration, fistula, lymph-node size, and common bile duct stenosis improved at reassessment in January 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tuberculosis should remain in the differential diagnosis of fluorodeoxyglucose-avid duodenal and biliary lesions in patients with autoimmune disease, particularly when biochemical obstruction, tumor markers, and tissue pathology do not fit malignancy. Early endoscopic biopsy and accessible nodal sampling can prevent unnecessary surgery and unsafe escalation of immunosuppression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1874119","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:22Z","timestamp":1783490302000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Duodenal tuberculosis with probable biliary involvement in primary Sj\u00f6gren\u2019s syndrome mimicking pancreatobiliary malignancy: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Jing","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xucheng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Guilin People\u2019s Hospital","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Guang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenzai","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"B1","article-title":"Global Tuberculosis Report 2025","year":"2025"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jctube.2023.100377","article-title":"Epidemiology and factors associated with extra-pulmonary tuberculosis in a low-prevalence area","volume":"32","author":"Rolo","year":"2023","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i40.14831","article-title":"Abdominal tuberculosis of the gastrointestinal tract: revisited","volume":"20","author":"Debi","year":"2014","journal-title":"World J Gastroenterol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v12.i23.5283","article-title":"Gastrointestinal tuberculosis: diagnostic approaches for this uncommon pathology","volume":"12","author":"Brown","year":"2024","journal-title":"World J Clin cases"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v12.i19.3648","article-title":"Recognizing and addressing the challenges of gastrointestinal tuberculosis","volume":"12","author":"Kudu","year":"2024","journal-title":"World J Clin cases"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v12.i32.6517","article-title":"Foregut tuberculosis: too close but miles apart","volume":"12","author":"Shahid","year":"2024","journal-title":"World J Clin cases"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v12.i8.1536","article-title":"Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: a case report and review of literature","volume":"12","author":"Ali","year":"2024","journal-title":"World J Clin cases"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2024.109618","article-title":"Primary pyloroduodenal tuberculosis presenting as gastric outlet obstruction. 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