Department of Gastroenterology, PSG Institute of Medical Sciences & Research, Coimbatore, India.
Department of Gastroenterology, St Luke Hospital, Pathanamthitta, Kerala, India.
J R Coll Physicians Edinb. 2024 Sep;54(3):257-259. doi: 10.1177/14782715241265144. Epub 2024 Jul 28.
A 57-year-old male with a background of chronic pancreatitis presented with acutely worsening abdominal pain and vomiting. He previously had a pancreatic duct stent which had been removed 1 year prior to presentation. Initially suspected to be acute-on-chronic pancreatitis, a computed tomography (CT) scan of the abdomen and pelvis revealed an atrophic pancreas and a new mass in the pancreatic head, raising the suspicion of pancreatic malignancy. An urgent endoscopic ultrasound (EUS)-guided fine needle biopsy of the pancreatic head mass surprisingly revealed the presence of actinomyces colonies on histological evaluation. Prompt initiation of a prolonged antibiotic course led to significant clinical and radiological improvement. This case highlights the rare presentation of pancreatic actinomycosis which can often masquerade as malignancy. Although a gut commensal, actinomyces can elicit pathogenic effects if allowed to enter tissues through a breach in the mucosal lining such as following abdominal surgery or pancreatic duct intervention as observed in this case. Early recognition and appropriate treatment with antibiotics can lead to clinical recovery and complete resolution of the infection.
一位 57 岁男性，有慢性胰腺炎病史，因急性腹痛和呕吐就诊。他之前曾进行过胰管支架置入术，该支架在就诊前 1 年已取出。最初怀疑为慢性胰腺炎急性发作，腹部和骨盆的计算机断层扫描（CT）显示胰腺萎缩和胰头部新肿块，提示胰腺恶性肿瘤。紧急进行的超声内镜（EUS）引导下胰头部肿块细针活检出人意料地显示组织学评估中存在放线菌菌落。及时开始长期抗生素治疗后，患者的临床和影像学症状均显著改善。本例提示罕见的胰腺放线菌病表现，其常表现为恶性肿瘤。虽然放线菌是肠道共生菌，但如果通过黏膜层的破裂（如本例中腹部手术后或胰管介入后）进入组织，就可能引发致病性作用。早期识别并使用抗生素进行适当治疗可导致临床康复和感染完全消退。
