Fulminant Emphysematous Pancreatic Pseudocyst: Infected with Normal Skin Flora

A 49-year-old man was alcoholic and had major depressive disorder. He experienced epigastric pain, poor appetite, and weight loss for 1 month. Ultrasonography of the abdomen revealed a pancreatic cyst (7 × 8 cm) with echogenic debris (Figure 1A). Contrast-enhanced computed tomography (CT) of the abdomen showed a complicated pancreatic pseudocyst (Figure 1B), compressed common bile duct, and dilated biliary tracts (Figure 1C). Laboratory data revealed an amylase level of 59 U/L (normal range: 28–100 U/L), a lipase level of 175 U/L (normal range: 22–51 U/L), a white blood cell count of 10700/µL (normal range: 4000–10000/µL), and a C-reactive protein level of 12.7 mg/L (normal range: 0–5 mg/L).