Abstract：
A 57-year-old man with a background of chronic pancreatitis presented with acutely worsening abdominal pain and vomiting. He previously had a pancreatic duct stent in situ 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.
摘要：
一名57岁的患有慢性胰腺炎的男子表现为腹痛和呕吐的急剧恶化。他以前有一个原位胰管支架，在就诊前1年被移除。最初怀疑是慢性急性胰腺炎，腹部和骨盆的计算机断层扫描（CT）扫描显示胰腺萎缩性和胰头新肿块，怀疑胰腺恶性肿瘤.对胰头肿块进行紧急内窥镜超声（EUS）引导的细针活检令人惊讶地发现，在组织学评估中存在放线菌菌落。迅速开始延长抗生素疗程可导致临床和放射学上的显着改善。此病例突出了胰腺放线菌病的罕见表现，通常可以伪装成恶性肿瘤。虽然肠道共生，如在这种情况下观察到的，如果放线菌通过粘膜衬里的破裂进入组织，例如在腹部手术或胰管介入之后，放线菌可以引起致病作用。早期识别和适当的抗生素治疗可以导致临床恢复和感染的完全解决。
