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Published on: January 2, 2026
From indeterminant to septic: the rapid transformation of a pancreatic lesion
Ayowumi A Adekolu1, Ethan M Cohen1, Vibhu Chittajallu2
1Section of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA.
Background And Aims:
Delineation of the malignant potential of pancreatic cystic lesions (PCLs) is important for management. Current guidelines recommend EUS-guided FNA (EUS-FNA) for PCLs that meet specific criteria. However, data are conflicting on the role of prophylactic antibiotics after EUS-FNA. We present 2 cases of undifferentiated pancreatic lesions that were infected after EUS sampling.
Methods:
Both patients developed signs and symptoms of sepsis after EUS sampling of PCLs. As a result, cystoduodenostomy with necrosectomy was performed for both cases with cyst wall biopsy.
Results:
The cystoduodenostomy with necrosectomy and cyst wall biopsy successfully drained the cyst, resolved the sepsis, and revealed the diagnosis of the PCL as a lymphoepithelial cyst (LEC).
Conclusions:
A LEC is a type of PCL that may carry a higher risk of infection for which prophylactic antibiotics should be considered. Postprocedure infections are rarely encountered with other cysts. Close observation and follow-up should be performed after EUS sampling of LECs given the risk of sepsis as seen in our cases despite prophylactic antibiotic use. EUS-guided drainage and debridement are effective for the management of infected LECs.
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