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Clostridium perfringens necrotizing pancreatitis: an unusual pathogen in pancreatic necrosis infection
Ana Sánchez-Gollarte1, Laura Jiménez-Álvarez1, Marina Pérez-González1
1Department of General and Visceral Surgery, Hospital Universitario Príncipe de Asturias, Spain.
Abstract:
Pancreatic necrosis infection (PNI) accounts for about 20-40 % of severe acute pancreatitis. PNI caused by anaerobic bacteria is unusual but when they present, Clostridium perfringens is the microorganism most commonly involved. We present a 60-year-old patient with a previous history of SARS-CoV-2, diagnosed with acute pancreatitis. During the hospitalisation he developed Clostridium perfringens bacteraemia. A CT-scan showed pancreatic gas gangrene and a surgical necrosectomy was performed. Clostridium perfringens was isolated in cultures of the pancreatic tissue and collections. The patient's clinical status improved after surgery and the appropriate medical therapy. He was discharged 76 days after admission. Nowadays, the 'step-up approach' is an accepted therapeutic tool in treatment of pancreatic necrosis and peripancreatic fluid collections. However, most authors suggest that Clostridum perfringens infection requires a more aggressive approach due to the high mortality associated to clostridial infection.
Insights
Clostridium perfringens infection is a rare but severe complication of acute pancreatitis. This case highlights the need for aggressive treatment in pancreatic necrosis infection caused by this anaerobic bacterium.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Surgical Pathology
Background:
- Pancreatic necrosis infection (PNI) complicates 20-40% of severe acute pancreatitis cases.
- Anaerobic bacterial PNI is uncommon, with Clostridium perfringens being the most frequent pathogen.
- Clostridium perfringens infections carry a high mortality rate.
Observation:
- A 60-year-old patient with prior SARS-CoV-2 infection developed acute pancreatitis.
- During hospitalization, the patient presented with Clostridium perfringens bacteremia.
- CT scan revealed pancreatic gas gangrene, necessitating surgical necrosectomy.
Findings:
- Clostridium perfringens was identified in pancreatic tissue and fluid cultures.
- The patient's condition improved following surgery and medical treatment.
- Discharge occurred 76 days after admission.
Implications:
- Clostridium perfringens PNI necessitates an aggressive treatment strategy due to high mortality.
- This case underscores the importance of considering unusual pathogens in severe pancreatitis.
- Prompt surgical intervention combined with appropriate antimicrobial therapy is crucial for favorable outcomes.
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