Tange Kazuhiro, Yokota Tomoyuki, Sunago Kotaro, Aono Michiko, Ochi Hironori, Takechi Shunji, Mashiba Toshie, Hida Akira Iino, Oshiro Yumi, Joko Kouji, Kumagi Teru, Hiasa Yoichi
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Department of Center for Liver and Biliary and Pancreatic Diseases, Matsuyama Red Cross Hospital, Bunkyo, Matsuyama, Ehime, 790-8524, Japan.
Clin J Gastroenterol. 2019 Feb;12(1):82-87. doi: 10.1007/s12328-018-0896-7. Epub 2018 Aug 28.
We experienced a rare case of acute pancreatitis caused by Candida infection. A 52-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Blood tests revealed high amylase and hepatobiliary enzyme abnormalities, and the patient was hospitalized for acute pancreatitis. Abdominal computed tomography showed a 15-mm space-occupying lesion at the parenchyma of the pancreatic head. Endoscopic retrograde cholangiopancreatography was performed after conservative treatment, which revealed a cystic lesion with a suspected solid component inside involving both lower bile duct and pancreatic duct. Cytology of collected bile and pancreatic juice revealed innumerous hyphae and spores morphologically consistent with Candida spp., as did endoscopic ultrasound-guided fine needle aspiration biopsy of the tumor site. Empiric therapy with oral fluconazole resulted in reduction of the space-occupying lesion 3 months after discharge. However, acute pancreatitis recurred about 1 year and 6 months after discharge. After conservative treatment was carried out again, the same lesion was fenestrated by endoscopic sphincteroplasty, and its internal solid components were resected using a basket catheter. Pathological analysis confirmed the presence of fungus balls and degenerated substances. Candida Albicans was identified by fungal culture examination. After the excretion of the fungus balls, pancreatitis did not recur thereafter during outpatient follow-up.
我们遇到了一例由念珠菌感染引起的罕见急性胰腺炎病例。一名52岁男性因腹痛为主诉入院。血液检查显示淀粉酶升高和肝胆酶异常，该患者因急性胰腺炎住院。腹部计算机断层扫描显示胰头实质有一个15毫米的占位性病变。保守治疗后进行了内镜逆行胰胆管造影，显示一个囊性病变，内部疑似有实性成分，累及下段胆管和胰管。收集的胆汁和胰液的细胞学检查发现大量形态与念珠菌属一致的菌丝和孢子，肿瘤部位的内镜超声引导下细针穿刺活检结果也是如此。口服氟康唑经验性治疗使出院后3个月占位性病变缩小。然而，出院后约1年6个月急性胰腺炎复发。再次进行保守治疗后，通过内镜括约肌切开术对同一病变进行开窗，并使用网篮导管切除其内部实性成分。病理分析证实存在真菌球和退变物质。通过真菌培养检查鉴定为白色念珠菌。真菌球排出后，门诊随访期间胰腺炎未再复发。
