Case Report: Pancreatic toxoplasmosis: role of endoscopic ultrasound in diagnosis.

Toxoplasmosis can present as systemic disease affecting many organs, especially in immunocompromised patients. Most cases of toxoplasmosis present as encephalitis, while extracerebral toxoplasmosis is rare, particularly within the gastrointestinal tract. Here, we report the case of a 48-year-old patient with toxoplasmosis presenting as pancreatic nodules, chronic pancreatitis and encephalitis. He was referred to our hospital for the evaluation of pancreatic lesions. The patient had been previously hospitalized due to hemiparesis and dizziness. Contrast-enhance brain magnetic resonance imaging (MRI) revealed a space-occupying lesion in the cerebellum with surrounding edema. Positron emission tomography (PET) scan demonstrated focal hypermetabolic sign in the head and body of pancreas, raising suspicion for primary pancreatic malignancy. Serum lipase was mildly elevated to less than twice the upper limit of normal. Meanwhile, amylase, Ca 19-9, and CEA levels were within normal limits. Endoscopic ultrasound (EUS) was subsequently performed and revealed multiple hypoechoic nodules in the pancreatic head and body. EUS-guided fine needle biopsy (FNB) using a 22-G acquire needle was carried out for further evaluation. Histopathological examination showed chronic inflammation of the pancreatic tissue without evidence of malignancy.