Fatal pancreatic pseudocyst co-infected by Raoultella planticola: an emerging pathogen

Abstract

Raoultella planticola is an aerobic Gram-negative bacterium belonging to the Enterobacteriaceae family. Initially identified in the 1980s, its pathogenic potential was further recognized when the first case of bacteremia was reported. Since then, only a few infections caused by this pathogen have been described. Although considered an opportunistic agent, fatal outcomes are associated with the infection by this pathogen, since it is more prevalent among the patients with immunodeficiency. The authors report the case of a middle-aged man diagnosed with end-stage renal disease and alcoholic pancreatitis, who was admitted to the emergency department with septic shock. Physical examination disclosed peritoneal irritation and a laparotomy was undertaken. Purulent peritonitis was found as well as a retroperitoneal abscess, which was drained. The postoperative period was troublesome, and the patient died. The autopsy showed a ruptured, infected pancreatic cyst and purulent peritonitis, among other findings. The culture of the peritoneal fluid and two blood sample sets were positive for R. planticola. The authors call attention to the importance of this emerging pathogen associated with severe gastrointestinal infections.

Acute Obstructive Suppurative Pancreatic Ductitis Caused by Raoultella planticola

“…Raoultella planticola has only rarely been identified as a cause of pancreatic infection, with only 2 previous reports of purulent peritonitis with a retroperitoneal abscess requiring surgical drainage 4,5 . Although the previous reports have suggested the severity of pancreatic infection due to R. planticola , our case had a favorable outcome due to prompt drainage of the pancreatic duct.…”

Ruptured Splenic Artery Pseudoaneurysm Causing Hemorrhage Into a Pancreatic Pseudocyst

“…The first referenced an infected pancreatic pseudocyst. 14 The second involved hemorrhage due to a necrotic pancreatic pseudocyst, but there was no involvement with the splenic artery, nor was there a cystogastrostomy stent placed. 15 Neither case exhibits the complex pathway of hemorrhage as we described in this report.…”

Community-acquired infection to Raoultella ornithinolytica presenting as appendicitis and shock in a healthy individual

“…One recent case of spontaneous peritonitis in a healthy individual was published [ 8 ]. As for R. planticola , reports included cases of pancreatitis, cholangitis, hepatic abscess, acute cholecystitis and peritoneal dialysis-associated peritonitis [ 5 , 9 ]. A case of gastroenteritis-associated bacteremia has been described in a patient who recovered uneventfully with antibiotics [ 10 ].…”