Abstract
Objective: A 50-year-old immunocompetent patient was hospitalized following an episode of acute necrotizing pancreatitis. Piperacillin/tazobactam was administered empirically. Despite continuous IV , on the 20th day of treatment the patient required urgent laparotomy. A swab sample was collected and subsequent Vancomycin with Amikacin administered empirically. Design: Despite administration of intensive treatment, general clinical condition of the patient deteriorated. The question was, why we experienced ineffectiveness of conservative treatment, as well as of subsequent surgical procedures? Was the microbiological specimen taken incorrectly? Why was it difficult to identify bacteria constituting the etiological infection source? Results: What is emphasized in our article is the significance of proper collection of a specimen and gathering an appropriate clinical history. What also needs to be taken into account in severe acute pancreatitis is perhaps allowing for longer bacterial culture growth. Conclusion: In this case, the infection was caused by a past injury with the previously undiagnosed etiological factor, i.e. Nocardia spp., challenging both current diagnosis and treatment, which ultimately resulted in severe necrotizing pancreatitis. This indicates the importance of a microbiologist for diagnosis and treatment.
Highlights
What needs to be taken into account in severe acute pancreatitis is perhaps allowing for longer bacterial culture growth
In this case, the infection was caused by a past injury with the previously undiagnosed etiological factor, i.e. Nocardia spp., challenging both current diagnosis and treatment, which resulted in severe necrotizing pancreatitis
In the reported case piperacillin/tazobactam was administered empirically which is frequently used against intestinal bacteria
Summary
Conclusion: In this case, the infection was caused by a past injury with the previously undiagnosed etiological factor, i.e. Nocardia spp., challenging both current diagnosis and treatment, which resulted in severe necrotizing pancreatitis. On the 7th day CT scan was performed again and piperacillin/ tazobactam was administered empirically since the patient’s general condition deteriorated. In the direct specimen Nocardia spp. was discovered, the bacteria was impossible to grow in spite of a 2-week-long culture time.
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