1309 Multi-Drug Resistant Burkholderia Cepacia Infected Pancreatic Pseudocyst

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INTRODUCTION: Burkholderia Cepacia is a gram negative bacillus that is most commonly associated with pneumonia in the immunocompromised, most specifically in the cystic fibrosis population. Pancreatic cysts have about 13.5% prevalence and are classified between non-neoplastic and neoplastic. Infected pseudocysts are non-neoplastic and a complication of pancreatitis. CASE DESCRIPTION/METHODS: A 45-year-old male with a past medical history of substance abuse, diabetes mellitus, and acute pancreatitis two weeks prior to admission presented to the ED unresponsive and hypoglycemic. Vitals were stable and physical exam was unremarkable on admission. With increased alertness he began endorsing epigastric abdominal pain, back pain, and early satiety. He then became febrile. Initially his labs were significant for: total bilirubin of 1.6 mg/dL, ALT 46 U/L, AST 65 U/L, and alkaline phosphate of 357 U/L. During the course of admission, his abdominal pain and satiety worsened, and his abdomen became distended. He became septic without a clear source. He underwent CT A/P, which demonstrated an 18.5 × 10.3 cm pseudocyst containing debris, thought to be a complication from his recent pancreatitis. The patient underwent CT guided biopsy for drainage and cultures, which grew MDR B. Cepacia. He was also found to have B. Cepacia bacteremia. The patient was started on Ceftazidime for a 2-month course. Unfortunately, after drainage the patient continued to have symptoms and his bilirubin peaked at 5.9 mg/dL and AP peaked at 1855 U/L. This led to a cyst gastrostomy stent placement via EUS. Two weeks later, a biliary sphincterotomy was performed by ERCP with stent removal and a single segmental biliary stricture was found in the lower and middle third of the main bile duct. Repeat CT A/P two weeks after the ERCP and one month after the start of antibiotics, showed a decrease in the size of the cyst to 8.5 × 3.2 cm and the patient's symptoms were improving. DISCUSSION: This was a unique case of a common complication of pancreatitis. Although infected pseudocysts are associated with mixed anaerobes and aerobes, B. Cepacia has not been commonly reported. To the best of our knowledge, this is the first case to be associated with B. Cepacia infected pseudocyst. As such, there is value in including uncommon MDR organisms in the differential for infected pseudocysts. Moreover, as this patient was immunocompetent, this poses an area of future study, as this patient's IVDA history may be an essential risk factor for these organisms.