Disclosure All authors disclosed no financial relationships. Commentary Actinomycosis is caused by an anaerobic, gram-positive bacillus bacterium and a normal occupant of the human mouth, respiratory, and GI tract. Culture of actinomyces shows a breadcrumb appearance and characteristic yellow sulfur granules. Most cases of actinomycosis in the GI tract occur after a perforation and rarely involve the biliary system. Reported actinomycotic biliary cases typically infect the gallbladder and present as classic cholecystitis with dense fibrotic adhesions seen on surgical resection. Few case reports have described actinomycosis limited to the bile ducts. In this case, the patient presented with obstructive jaundice and imaging concerning for cholecystitis and choledocholithiasis. ERCP revealed a CHD stricture without evidence of stones. SpyGlass identified atypical whitish dense structures within the bile duct, and actinomyces infection was confirmed on pathologic examination, ruling out malignancy. The infection was successfully cleared with high-dose, long-term penicillin therapy, which is required because of the severe desmoplastic reaction that occurs with infection and limits drug penetration. This is a rare and perhaps somewhat fortunate outcome for a patient with a CHD stricture, given that more often malignancy is expected. Courtney Walker, DO, Department of Gastroenterology, St. Charles Medical Center, Bend, Oregon, USA Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points