Acute interstitial pancreatitis with Burkholderia cenocepacia pseudocyst in an immunocompetent host: A case report on an atypical presentation and review of literature

We report an atypical occurrence of a Burkholderia cenocepacia-infected pancreatic pseudocyst in an immunocompetent patient. A 24-year-old male presented to the clinic with a history of sudden-onset intermittent abdominal pain and fever for the past 3 days. Examination found a soft abdomen, with epigastric and left lumbar tenderness with guarding. An abdominal ultrasound revealed a gaseous abdomen with mild hepatosplenomegaly and three anechoic collections in the pancreas with septations, suspected to be pseudocysts in the uncinate process and body of the pancreas. A pigtail catheter was inserted to drain the pus-filled cyst, and the fluid culture was positive for ceftazidime-sensitive Burkholderia cenocepacia using MALDI-TOF of growth from culture in blood and McConkey agar. The regimen of Inj Ceftazidime for 21 days was started. A pigtail catheter was used to drain the pancreatic collection till the drained fluid was less than 10 mL for 3 days. The patient was discharged in good condition. This case presents an uncommon presentation of Burkholderia cepacia complex infection in a pseudocyst, particularly in an immunocompetent host, which provides a unique insight into the novel properties of the bacteria, including elevated endotoxin-like lipopolysaccharide activity, which is essential in the pathogenesis in this case or similar presentations.