Abstract
A 74-year-old woman presented because of fever and abdominal pain for 1 month. She had undergone cholecystectomy and choledochojejunostomy to treat choledocholithiasis 34 years previously, followed by intrahepatic lithiasis treated by a plastic biliary stent, which remained in place for 14 years. Blood tests revealed an inflammatory response. CT revealed a heterogeneously enhanced mass of approximately 80 mm in the pancreas (A), and fluorodeoxyglucose positron emission tomography with CT showed abnormally high uptake in the mass (B). Histologic examination of material obtained by EUS-guided FNA revealed sulfur granules of Actinomyces with branching bacterial filaments (C, D), leading to a diagnosis of pancreatic actinomycosis. Treatment with intravenous ampicillin/sulbactam for 2 weeks and oral amoxicillin/clavulanate for another 12 months resulted in rapid clinical improvement. Informed consent was obtained from the patient for the publication of her information and imaging.
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