Zaid Sam, Mahmoud Ahmed, Barry Maged, Yavrouian Robert
Department of Surgery, San Joaquin General Hospital , French Camp, California.
Surg Infect (Larchmt). 2013 Dec;14(6):554-8. doi: 10.1089/sur.2012.169. Epub 2013 Oct 25.
The lung is the most common site of coccidioidomycosis, with extrapulmonary sites of infection being described rarely. To date, the pancreas has not been reported as an isolated site of coccidioidomycosis.
Case report and literature review.
Computed tomography (CT)-guided biopsy and gram staining of the pancreatic lesion of an immunocompetent patient without known risk factors revealed coccidioidomycosis of the head of the pancreas without malignant neoplasm or atypia. Serologic tests yielded positive titers for antibodies to Coccidioides lmmitis. The patient responded to treatment with fluconazole, as evidenced by regression of her pancreatic lesion by CT and negative serologic test results for Coccidioides upon completion of treatment.
Solid masses in the head of the pancreas encountered in surgical practice are challenging in terms of both surgical technique and diagnosis. Although malignant disease remains a high possibility in the differential diagnosis of such masses, and must always be considered until proved to be absent, non-malignant etiologies should also be considered. In a number of patients with benign lesions of the pancreatic head, unnecessary surgical exploration and resection is avoidable. Although they are rare, several fungal infections of the pancreas have been reported in the literature. The unusual case of coccidioidomycosis of the pancreatic head presented here adds to the list of uncommon causes of pancreatic lesions. Surgeons and physicians managing patients in areas in which coccidioidomycosis is endemic should be aware of this rare entity.
肺部是球孢子菌病最常见的发病部位，肺外感染部位鲜有报道。迄今为止，胰腺尚未被报道为球孢子菌病的单一发病部位。
病例报告及文献综述。
对一名无已知危险因素的免疫功能正常患者的胰腺病变进行计算机断层扫描（CT）引导下活检及革兰氏染色，结果显示胰腺头部为球孢子菌病，无恶性肿瘤或异型性。血清学检测显示针对粗球孢子菌抗体的滴度呈阳性。患者接受氟康唑治疗后有反应，CT显示其胰腺病变消退，治疗结束时针对球孢子菌的血清学检测结果为阴性，证明了这一点。
在外科实践中遇到的胰腺头部实性肿块在手术技术和诊断方面都具有挑战性。尽管在对此类肿块的鉴别诊断中恶性疾病仍然很有可能，并且在被证明不存在之前必须始终予以考虑，但也应考虑非恶性病因。对于一些胰腺头部良性病变患者，可避免不必要的手术探查和切除。虽然胰腺的真菌感染很少见，但文献中已有数例报道。本文介绍的胰腺头部球孢子菌病这一不寻常病例增加了胰腺病变罕见病因的种类。在球孢子菌病流行地区治疗患者的外科医生和内科医生应了解这一罕见疾病。
