Fulminant Emphysematous Pancreatic Pseudocyst: Infected with Normal Skin Flora

Abstract

A 49-year-old man was alcoholic and had major depressive disorder. He experienced epigastric pain, poor appetite, and weight loss for 1 month. Ultrasonography of the abdomen revealed a pancreatic cyst (7 £ 8 cm) with echogenic debris (Figure 1A). Contrast-enhanced computed tomography (CT) of the abdomen showed a complicated pancreatic pseudocyst (Figure 1B), compressed common bile duct, and dilated biliary tracts (Figure 1C). Laboratory data revealed an amylase level of 59 U/L (normal range: 28-100 U/L), a lipase level of 175 U/L (normal range: 22-51 U/L), a white blood cell count of 10,700/mL (normal range: 4000-10,000/mL), and a C-reactive protein level of 12.7 mg/L (normal range: 0-5 mg/L). After 1 week of intravenous antibiotic treatment, his condition deteriorated, and he was referred to a medical center. In the emergency department, one episode of pulseless ventricular tachycardia was noted; his spontaneous circulation was restored after cardiopulmonary resuscitation. Follow-up CT showed emphysematous changes in the pancreatic pseudocyst, and percutaneous drainage of the abscess was performed under CT guidance by using a 10-Fr pigtail catheter (Figure 2A). Because pseudocyst rupture was suspected, a contrast medium was injected into the abscess cavity, and no leakage or fistula formation was observed (Figure 2B). Corynebacterium striatum was isolated from the drained pus but not from the patient's blood. His condition improved, and he was discharged after treatment.