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The pancreatic pseudocyst, although still present, decreased in size to 8.5 x 3.2 cm two weeks after aspiration and four weeks after initiation of antibiotics.
Source publication
Burkholderia cepacia is a gram-negative bacillus that is most commonly associated with pneumonia in the immunocompromised patients. The most common organisms associated with pancreatic infections are Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., and Enterococcus spp. We report a case of a 45-year-old gentleman with recent acute pancre...
Context in source publication
Context 1
... weeks later, a repeat ERCP resulted in a biliary sphincterotomy with stent placement and removal of the previously placed AXIOS stent. Repeat CT A/P two weeks after the ERCP and one month after starting antibiotics showed a decrease in the size of the cyst to 8.5 x 3.2 cm ( Figure 3) [1]. ...
Citations
... Infectious ailments of pancreatic pseudocysts remain a widely known Table 1 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. In 2018, Shi et al. presented the case of a 26-year-old Chinese woman presenting with severe acute pancreatitis with subsequent hospitalization [6]. ...
... In another case report, a 45-year-old man was hospitalized for a constellation of symptoms, characterized by early satiety, worsening epigastric pain, hypoglycemia, and altered mental status three weeks after his hospitalization for acute pancreatitis [7]. He began experiencing these symptoms while at a rehabilitation facility, as his acute pancreatitis episode was presumed secondary to alcohol abuse. ...
... A day two abdominal computed tomography (CT) scan revealed a mass consistent with a pancreatic pseudocyst, and blood cultures revealed Burkholderia cepacia resistant to amikacin, cefepime, ciprofloxacin, gentamicin and piperacillin-tazobactam and sensitive to ceftazidime, meropenem, and trimethoprim-sulfamethoxazole (TMP-SMX). By day 10 of ceftazidime treatment, the patient continued to experience spiking fevers [7]. A CT-guided drainage of the pseudocyst with culture revealed multidrug-resistant (MDR) B. cepacia, Candida dubliniensis, and Candida glabrata. ...
Introduction
Pancreatic pseudocysts remain a feared complication of acute or chronic pancreatitis and are often characterized by collections of fluids due to underlying damage to the pancreatic ducts, culminating in a walled-off region bereft of an epithelial layer but surrounded by granulation tissue. While fungal infections of pancreatic pseudocysts are rarely encountered, candida albicans remains the most frequently implicated organism.
Case presentation
A 55-year-old male presented with pain in the left-hypochondriac region, accompanied by non-bilious emesis and nausea. Interestingly, the patient also tested positive for a COVID-19 infection. Investigative workup divulged enhancing pancreatic walls with a radiologic impression consistent with a pancreatic pseudocyst. An ultrasound-guided external drainage was performed; the drainage was conducted unremarkably, with the resultant fluid collection revealing the presence of Candida Glabrata. The patient was commenced on antifungal therapy and continues to do well to date.
Discussion
Infectious ailments of pancreatic pseudocysts remain a widely known complication of acute pancreatitis. While it is rare, fungal infection is a crucial consideration for patients with pancreatic pseudocysts, especially in the context of a lack of an adequate response to antibiotics, deterioration, comorbidities, and immunocompromised states.
Conclusion
Rapid identification of the microbe responsible for pancreatic pseudocyst infection is vital for time-sensitive treatment and a more rapid recovery, curbing associated morbidity and mortality.
... We found a paucity of literature describing pancreatic pseudocyst infection with Burkholderia species [3,4]. The first reported case had multidrug resistant Burkholderia Cepacia where he received inj ceftazidime for 2 months followed by EUS guided drainage with positive blood culture for the same agent. ...
