Hepatic actinomycosis after total pancreatectomy: A case rep
Hepatic actinomycosis (HA) is a rare infection mimicking a malignancy. Total pancreatectomy and gastrointestinal surgeries were the causable factors. Typically, penicillin therapy is recommended for over 6 months. Surgical exploration was important in avoiding unnecessary hepatectomy.

A 70-year-old woman with a history of gastrectomy and sigmoidectomy for benign lesions underwent a total pancreatectomy for a non-invasive, intraductal papillary mucinous carcinoma (IPMC). She required partial resection of the transverse colon due to insufficient blood flow and had an anastomotic failure.

Four months later, she developed a fever and effusion from the upper abdominal midline incision. No bacteria were cultured from the effusion. Contrast-enhanced computed tomography demonstrated an 80-mm iso-vascular liver mass.

Slightly high signal intensity on T2-weighted magnetic resonance imaging was demonstrated. Positron emission tomography (PET) showed a standardized uptake value of 11.9 at the liver mass. The percutaneous liver biopsy did not establish a diagnosis. Because a malignancy could not be ruled out, an exploratory laparotomy was performed. A tissue sample revealed aggregates of branched filamentous microorganisms; actinomycosis was diagnosed. Oral amoxicillin for 4 months resolved the mass.

A rare case of HA mimicking a malignancy after total pancreatectomy for IPMC is presented.

International Journal of Surgery Case Reports
Source: https://doi.org/10.1016/j.ijscr.2021.106212