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A rare case of acute pancreatitis caused by Candida Albicans
Kazuhiro Tange1,2, Tomoyuki Yokota2, Kotaro Sunago1,2
1Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Abstract:
We experienced a rare case of acute pancreatitis caused by Candida infection. A 52-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Blood tests revealed high amylase and hepatobiliary enzyme abnormalities, and the patient was hospitalized for acute pancreatitis. Abdominal computed tomography showed a 15-mm space-occupying lesion at the parenchyma of the pancreatic head. Endoscopic retrograde cholangiopancreatography was performed after conservative treatment, which revealed a cystic lesion with a suspected solid component inside involving both lower bile duct and pancreatic duct. Cytology of collected bile and pancreatic juice revealed innumerous hyphae and spores morphologically consistent with Candida spp., as did endoscopic ultrasound-guided fine needle aspiration biopsy of the tumor site. Empiric therapy with oral fluconazole resulted in reduction of the space-occupying lesion 3 months after discharge. However, acute pancreatitis recurred about 1 year and 6 months after discharge. After conservative treatment was carried out again, the same lesion was fenestrated by endoscopic sphincteroplasty, and its internal solid components were resected using a basket catheter. Pathological analysis confirmed the presence of fungus balls and degenerated substances. Candida Albicans was identified by fungal culture examination. After the excretion of the fungus balls, pancreatitis did not recur thereafter during outpatient follow-up.
Insights
A rare case of acute pancreatitis caused by Candida infection was successfully treated. Surgical intervention to remove fungus balls resolved the infection and prevented recurrence of pancreatitis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Medical Mycology
Background:
- Acute pancreatitis is a serious condition often caused by gallstones or alcohol.
- Candida infections are typically superficial but can become invasive in immunocompromised individuals.
- Pancreatic involvement by Candida is exceptionally rare, presenting diagnostic and therapeutic challenges.
Observation:
- A 52-year-old male presented with abdominal pain and laboratory/imaging findings consistent with acute pancreatitis.
- Imaging revealed a pancreatic head lesion later identified as containing Candida hyphae and spores.
- Initial fluconazole therapy reduced the lesion, but pancreatitis recurred.
Findings:
- Endoscopic retrograde cholangiopancreatography and ultrasound-guided biopsy confirmed Candida infection within a pancreatic lesion.
- Surgical fenestration and resection of fungus balls led to the resolution of pancreatitis.
- Fungal culture identified Candida Albicans as the causative agent.
Implications:
- This case highlights the potential for Candida to cause acute pancreatitis, even in non-immunocompromised patients.
- Effective management requires accurate diagnosis and may involve surgical intervention to remove fungal masses.
- Early recognition and treatment of invasive Candida infections in the pancreas can prevent severe complications and recurrence.
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