Actinomycosis Involving Chronic Pancreatitis: A Case Report with Literature Review

Seong Jae Yeo; Chang-Min Cho; Min Kyu Jung; Ki Ju Kim; Myung Hi Kim; Seung Hyun Cho; Gab Chul Kim; Na Seo

doi:10.4166/kjg.2017.69.3.191

Journal List > Korean J Gastroenterol > v.69(3) > 1007627

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Yeo, Cho, Jung, Kim, Kim, Cho, Kim, and Seo: Actinomycosis Involving Chronic Pancreatitis: A Case Report with Literature Review

Case Report

Korean J Gastroenterol 2017;69(3):191-195.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.3.191

Actinomycosis Involving Chronic Pancreatitis: A Case Report with Literature Review

Seong Jae Yeo, Chang-Min Cho, Min Kyu Jung, Ki Ju Kim, Myung Hi Kim, Seung Hyun Cho¹, Gab Chul Kim¹, Na Seo²

Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea

¹Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea

²Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence to: Chang-Min Cho, Department of Internal Medicine, Kyungpook National University Medical Center, 807 Hokuk-ro, Buk-gu, Daegu 41404, Korea. Tel: +82-53-200-2608, Fax: +82-53-200-2028, E-mail: cmcho@knu.ac.kr

Received 2 January 2017 Revised 20 February 2017 Accepted 21 February 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anae-robic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.

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Keywords: Actinomycosis, Endosonography, Fine needle biopsy, Pancreas

References

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Fig. 1.

Computed tomography scan images. (A) Multiple calcifications and stones (black arrows) were also noted in the head of the pancreas. (B) Contrast-enhanced axial image (portal phase) revealed diffuse parenchymal swelling with multiple calcification (black arrows) at the body of the pancreas. (C) Contrast-enhanced coronal image (portal phase) showed heterogeneous enhancement of the pancreas parenchyma and peripancreatic strands (white arrows). (D) Multifocal uneven pancreatic duct dilation (white asterisk) was also observed.

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Fig. 2.

Endoscopic ultrasonography (EUS) images. (A) A 19-mm sized, ill-defined, hypoechoic and heterogenous mass with central calcification was identified at the pancreatic tail. (B) EUS-guided fine needle aspiration biopsy using a 20-gauge needle was performed.

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Fig. 3.

Microscopic findings for the specimen. The specimen revealed sulfur granules, consisting of a conglomeration of filamentous bacteria, which was shown at the surrounding tissue with dense inflammatory infiltration by lymphocytes, neutrophils, and foamy macrophages (A, hematoxylin and eosin stain, ×100; B, hematoxylin and eosin stain, ×400).

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Fig. 4.

Computed tomography image. Contrast-enhanced axial image (portal phase) revealed remarkable regression of pancreatic inflammatory swelling and peripancreatic inflammatory infiltration.

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