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Updated: Oct 25, 2025
Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Infected pancreatic necrosis and retroperitoneal abscess associated with Lactobacillus paracasei
Toshiki Miwa1, Hajime Tanaka2, Toshiaki Shiojiri2
1General internal medicine, Asahi General Hospital, Asahi, Chiba, Japan toshiki.miwa1993@gmail.com.
Abstract:
Infected pancreatic necrosis is a postpancreatitis complication that is mainly caused by Enterobacteriaceae and Enterococci. Here, we have reported a very rare case of Lactobacillus paracasei bacteraemia associated with infected pancreatic necrosis and retroperitoneal abscess. In addition to the diagnosis of diabetic ketoacidosis, blood test results revealed a high inflammatory status. CT of the abdomen revealed pancreatic walled-off necrosis. Blood culture and aspiration fluid culture revealed positivity for L. paracasei, leading to the diagnosis of infected pancreatic necrosis. The abscess had spread in the retroperitoneal space later. The patient recovered after receiving antibiotic treatment and endoscopic and percutaneous drainage. L. paracasei can cause invasive infection, including infected pancreatic necrosis and retroperitoneal abscess, which requires aggressive therapy.
Insights
A rare case of Lactobacillus paracasei caused infected pancreatic necrosis and a retroperitoneal abscess. Aggressive treatment, including antibiotics and drainage, led to patient recovery.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Infected pancreatic necrosis is a serious complication of pancreatitis, typically caused by Enterobacteriaceae and Enterococci.
- Lactobacillus paracasei is a commensal bacterium not usually associated with severe invasive infections.
Observation:
- A patient presented with diabetic ketoacidosis and signs of severe inflammation.
- Abdominal CT revealed walled-off pancreatic necrosis.
- Blood and fluid cultures identified Lactobacillus paracasei as the causative agent.
Findings:
- The patient was diagnosed with infected pancreatic necrosis and a subsequent retroperitoneal abscess caused by Lactobacillus paracasei.
- Successful treatment involved a combination of antibiotics and both endoscopic and percutaneous drainage procedures.
Implications:
- Lactobacillus paracasei can be an opportunistic pathogen causing severe invasive infections like infected pancreatic necrosis and retroperitoneal abscess.
- Prompt diagnosis and aggressive, multi-modal therapy are crucial for managing these rare but serious infections.
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