Unveiling the Uncommon: A Rare Case of Infected Intraductal Papillary Mucinous Neoplasm of Pancreas
Recommended Citation
Arif TB, Ihsan R, Rahman AU, Khan MZ. Unveiling the Uncommon: A Rare Case of Infected Intraductal Papillary Mucinous Neoplasm of Pancreas. Am J Gastroenterol 2024; 119(10):S1714.
Document Type
Conference Proceeding
Publication Date
10-1-2024
Publication Title
Am J Gastroenterol
Abstract
Introduction: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas involves papillary growths within its ductal system. Complications, though extremely rare, include infections due to rupture, fistulization, or malignant transformation. We report a case of infected IPMN in a 76-year-old man with recurrent abdominal pain, treated successfully with cyst drainage and antibiotics. Case Description/Methods: A 76-year-old man with a history of chronic obstructive pulmonary disease, prediabetes, and pancreatic cyst (on pancrelipase) presented with diffuse abdominal pain for 3 hours. He had a previous presentation 5 days ago with worsening abdominal pain, fever, chills, and nausea. Magnetic resonance cholangiopancreatography (MRCP) at that time showed a cystic mass affecting the left renal vein and pancreas, prompting a referral for endoscopic ultrasound (EUS). On examination, he had minor wheezes and mild diffuse abdominal tenderness. Labs showed elevated liver biochemistry panel, leukocytosis, and anemia. Computed tomography scan revealed a possible abscess connected to the known pancreatic cyst. Abdominal ultrasound suggested acute cholecystitis possibly related to the pancreatic mass. EUS showed pancreatic duct dilation and a heterogeneous lesion posterior to the left lobe of the liver. Fine needle aspiration (FNA) revealed inflammatory debris and pseudomonas aeruginosa growth in the drainage culture. Pancreatic cyst CEA was elevated with low amylase, indicating an infected IPMN. Antibiotics were continued, and the patient was discharged with oral therapy (ciprofloxacin and metronidazole) for follow-up imaging with gastroenterology. Discussion: This is the fourth known case of spontaneous IPMN infection. Previous cases involved patients with sepsis and multilocular cystic tumors, with one case being asymptomatic. All cases were treated with cyst drainage and antibiotics. Our case showed infection with pseudomonas aeruginosa. The pathogenesis is unclear, potentially involving retrograde bacterial translocation due to papillary orifice dilation or other factors like alcohol-induced pancreatitis or immunosuppression associated with diabetes. Imaging may show unusual fluid layering, with EUS revealing clumped mucin. Management typically involves drainage and antibiotics, with considerations for resection in cases of dysplastic transformation. Our case did not require resection as no malignancy was observed. Spontaneous IPMN infection is rare, varying from asymptomatic to severe sepsis. EUS-guided FNA can aid in diagnosis and management (Figure 1).
Volume
119
Issue
10
First Page
S1714
