P1147 - A Rare Case of Spontaneous Fungal Peritonitis Caused by Candida lusitaniae in a Patient With Necrotizing Pancreatitis

Bianca Varda, MD¹, Mustafa Alani, MD², Hursh Sarma, MD¹, Shifat Ahmed, MD^1
1St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Phoenix, AZ; ²Creighton University/St. Joseph's Medical Center, Phoenix, AZ

Introduction: Candida lusitaniae is a fairly rare cause of peritonitis. A PubMed search using the keywords “Candida+lusitaniae+peritonitis” revealed 9 results, most of which were associated with peritoneal dialysis. Here, we present a case of spontaneous fungal peritonitis caused by C. lusitaniae in a patient with necrotizing pancreatitis.

Case Description/Methods: A 33-year-old female with a history of chronic pancreatitis secondary to alcohol abuse was transferred to our hospital due to a 3-week history of left-sided abdominal pain with radiation to the rest of her abdomen and left flank. During this time, she also reported nausea and bilious emesis. On presentation, the patient was afebrile and hemodynamically stable. Physical examination was remarkable for a moderately distended abdomen with diffuse tenderness to palpation. Labs were significant for a WBC count of 54.0 thousand/uL, Hgb of 9.9 gm/dL, total bilirubin of 2.2 mg/dL, ALT of 66 U/L, AST of 151 U/L, and alkaline phosphatase of 473 U/L. CTA was obtained which showed severe pancreatitis with hemorrhagic peripancreatic fluid and a moderately-sized fluid collection extending along the greater curvature of the stomach with a hypoperfused spleen. The patient underwent EUS with cystgastrostomy tube placement followed by EGD with necrosectomy two days later. Following the procedure, she continued to complain of abdominal pain and had a persistently elevated white count despite broad spectrum antibiotics. Her abdomen also remained distended due to increasing ascites and the patient underwent paracentesis. Fluid studies revealed a SAAG less than 1.1 consistent with pancreatitis. Culture from the fluid later grew Candida lusitaniae and the patient was treated with a regimen of meropenem and fluconazole. She continued to improve while in the hospital and was scheduled for outpatient follow-up.

Discussion: Acute necrotizing pancreatitis is most commonly caused by choledocholithiasis and alcohol abuse. The inflammation can be associated with pancreatic fluid collections, walled-off necrosis, and pseudocyst development. Treatment consists of necrosectomy 3-4 weeks after the initial insult which provides time for encapsulation of the collections. One possible complication of pancreatitis is peritonitis, most commonly spontaneous bacterial peritonitis. Candida lusitaniae is an opportunistic fungal infection with a high mortality usually seen in association with peritoneal dialysis. Treatment with antifungal agents is especially important to reduce complications.


Disclosures:
Bianca Varda indicated no relevant financial relationships.
Mustafa Alani indicated no relevant financial relationships.
Hursh Sarma indicated no relevant financial relationships.
Shifat Ahmed indicated no relevant financial relationships.


Bianca Varda, MD¹, Mustafa Alani, MD², Hursh Sarma, MD¹, Shifat Ahmed, MD¹. P1147 - A Rare Case of Spontaneous Fungal Peritonitis Caused by Candida lusitaniae in a Patient With Necrotizing Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.