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 (7โ€ฏร—โ€ฏ8 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: 28โ€“100 U/L), a lipase level of 175 U/L (normal range: 22โ€“51 U/L), a white blood cell count of 10700/ยตL (normal range: 4000โ€“10000/ยตL), and a C-reactive protein level of 12.7 mg/L (normal range: 0โ€“5 mg/L).

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