Primary Pancreatic Candidiasis Mimicking Pancreatic Cancer in an Immunocompetent Patient

Abstract

Pancreatic candidiasis can develop in patients with acute pancreatitis, compromised immune responses, or iatrogenic intervention. This paper reports a case of pancreatic candidiasis presenting as a solid pancreatic mass in a patient without the risk factors. A previously healthy 37-year-old man visited the emergency department with left flank pain. Abdominal CT revealed a 5 cm, irregular heterogeneous enhancing mass accompanied by a left adrenal mass. Positron emission tomography-computed tomography and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) could not discriminate pancreatic cancer from infectious disease. A laparoscopic exploration was performed for an accurate diagnosis. After distal pancreatectomy with splenectomy and left adrenalectomy, pancreatic candidiasis and adrenal cortical adenoma were diagnosed based on the pathology findings. His condition improved after the treatment with fluconazole. This paper reports a case of primary pancreatic candidiasis mimicking pancreatic cancer in an immunocompetent patient with a review of the relevant literature.

Disseminated Nocardiosis: The Complexity of the Diagnosis

“…Infections of the CNS by Nocardia spp. typically present as meningitis or sub-acute abscess and account for 1-2% of brain abscesses [ 1 , 3 , 6 ], with a mortality rate of 20% in immunocompetent patients [ 1 ], higher in those immunocompromised patients or those with known risk factors [ 1 , 7 ]. The median incubation time to detect Nocardia bacteriemia is 3 - 5 days [ 4 ], and a specific ribosomal ribonucleic acid (rRNA) sequencing is needed for the identification of the species [ 7 ], which is a challenge in the diagnosis in many hospitals.…”

“…Infections by Nocardia spp . are rare in healthy individuals, but more common in immunocompromised patients [ 3 ]. Risk factors include long-term corticosteroid and other immunosuppressor therapies, malignancy, human immunodeficiency virus (HIV) infection, diabetes and alcoholism [ 4 ].…”