Abstract
A 71-year-old man who had undergone total gastrectomy, partial pancreatectomy, and splenectomy with Roux-en-Y reconstruction for gastric cancer was referred for a possible pancreatic tail tumor. Contrast-enhanced computed tomography showed mold-like, poor contrast lesion in the dilated main pancreatic duct in the pancreatic tail. Endoscopic ultrasonography revealed a slightly hyperechoic solid lesion that occupied the lumen of the main pancreatic duct. Linear calcification was observed in the lesions on both computed tomography and endoscopic ultrasonography, and endoscopic ultrasound-guided fine-needle biopsy was performed. Histopathology revealed sulfur grains and inflammatory infiltrates with no malignant findings. We also performed an anaerobic culture using fine-needle biopsy specimens, and Actinomyces meyeri was detected in the culture results. After confirming susceptibility, oral administration of amoxicillin was initiated. After 8 months of treatment, the size of the lesion slightly decreased, and the antibiotics treatment is still ongoing. This shows that such cases could be diagnosed based on histological findings and anaerobic culture using a fine-needle biopsy specimen, and unnecessary surgery may be avoided. In the case of tumors developed in the residual pancreas without typical malignant imaging findings, pancreatic actinomycosis should be considered as a differential diagnosis.
Similar content being viewed by others
Abbreviations
- EUS-FNB:
-
Endoscopic ultrasound-guided fine-needle biopsy
- CT:
-
Computed tomography
- FDG:
-
Fluorodeoxyglucose
- EUS:
-
Endoscopic ultrasonography
References
Jha A, Yiengpruksawan A, Christiano AA, et al. Actinomycosis of the pancreas: a case report and review. Gastroenterol Res. 2010;3:134–8.
Weese WC, Smith IM. A study of 57 cases of actinomycosis over a 36-year period. A diagnostic ‘failure’ with good prognosis after treatment. Arch Intern Med. 1975;135:1562–8.
Ota Y, Endo M, Akutsu Y, et al. A case of ileocecal actinomycosis with a review of 170 cases reported in Japan. Jpn J Gastroenterol Surg. 2004;65:2934–8.
De Clerck F, Laukens P, De Wilde V, et al. A suspicious pancreatic mass in chronic pancreatitis: pancreatic actinomycosis. Case Rep Oncol Med. 2015;2015:767365.
Parsons HH. Actinomycosis of pancreas: report of case. Calif West Med. 1931;35:452.
Lee JH, Lee KG, Oh YH, et al. Actinomycosis of the pancreas: a case report and review of the literature. Hepatogastroenterology. 2010;57:358–61.
Kuesters S, Timme S, Keck T. Uncommon cause of an inflammatory pancreatic head tumor. Diagnosis: purulent actinomycosis and incidental T1-carcinoid of the pancreatic head. Gastroenterology. 2011;141:e9–10.
Murakami M, Koneri K, Goi T, et al. A case of pancreas actinomycosis mimicking lower bile duct cancer. Jpn J Gastroenterol Surg. 2011;44:1151–7.
Nakazono T, Kadono J, Tabata M, et al. Pancreatic actinomycosis after pancreaticoduodenectomy. Jpn J Gastroenterol Surg. 2016;49:1117–23.
Somsouk M, Shergill AK, Grenert JP, et al. Actinomycosis mimicking a pancreatic head neoplasm diagnosed by EUS-guided FNA. Gastrointest Endosc. 2008;68:186–7.
Sahay SJ, Gonzalez HD, Luong TV, et al. Pancreatic actinomycosis as a cause of retroperitoneal fibrosis in a patient with chronic pancreatitis. Case report and literature review. JOP. 2010;11:477–9.
Maestro S, Trujillo R, Geneux K, et al. Pancreatic actinomycosis presenting as pancreatic mass and diagnosed with endoscopic ultrasound fine needle aspiration (EUS-FNA). Endoscopy. 2013;45:E276–7.
Kim MC, Lee HK, Park JO, et al. A solitary pancreatic actinomycosis mimicking pancreatic cancer. Korean J Pancreas Biliary Tract. 2015;20:130–5.
Yeo SJ, Cho CM, Jung MK, et al. Actinomycosis involving chronic pancreatitis: a case report with literature review. Korean J Gastroenterol. 2017;69:191–5.
Sogabe Y, Yamamoto S, Kodama Y. Unusual cause of a pancreatic mass. Gastrointest Endosc. 2018;88:770–1.
Magrì S, Paduano D, Cappai M, et al. Primary pancreatic actinomycosis: a case report and literature review. Endosc Ultrasound. 2019;8:354–5.
Harsch IA, Benninger J, Niedobitek G, et al. Abdominal actinomycosis: complication of endoscopic stenting in chronic pancreatitis? Endoscopy. 2001;33:1065–9.
Asano Y. A case of actinomycosis of the nasal cavity. Jibi inkoka rinsho. 2010;129:26–30.
Acevedo F, Baudrand R, Letelier LM, et al. Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature. Int J Infect Dis. 2008;12:358–62.
Sudhakar SS, Ross JJ. Short-term treatment of actinomycosis: two cases and a review. Clin Infect Dis. 2004;38:444–7.
Sugawa C, Kon Y, Lucas CE, et al. Assessment of antimicrobial penetrance into the pancreatic juice. Gastroenterol Endosc. 1988;30:678–82.
Author information
Authors and Affiliations
Contributions
KMI and KMA: Conceptualization of the research and writing of the paper. KO, KF, SH, RT, and SF: Critical revision of the article and contribution of important content.
Corresponding author
Ethics declarations
Conflict of interest
Kazuya Miyamoto, Kazuyuki Matsumoto, Kazuki Ocho, Koji Fujita, Shigeru Horiguchi, Ryuta Takenaka and Shigeatsu Fujiki declare that they have no conflict of interest.
Ethical approval
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from the patient for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Miyamoto, K., Matsumoto, K., Ocho, K. et al. Pancreatic actinomycosis treated by antibiotics after diagnosis using endoscopic ultrasound-guided fine-needle biopsy. Clin J Gastroenterol 14, 1785–1790 (2021). https://doi.org/10.1007/s12328-021-01523-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-021-01523-2