Pancreatitis Case Studies

TITLE: SALMONELLA ENTERITIDIS BACTEREMIA, A CAUSE FOR ACUTE PANCREATITIS?

Authors: Merjona Saliaj, MD, Sikka Gautam, MD, Norbert Brau, MD

Institutions: Icahn School of Medicine at Mount Sinai (Bronx); James J. Peters VA Bronx Medical Center

North Central Bronx Hospital

INTRODUCTION

Pancreatitis associated with bacterial infection has been previously studied. Several case reports have described Salmonella as a possible cause of pancreatitis. Two retrospective studies have shown increased levels of pancreatic enzymes and clinical pancreatitis in patients infected with Salmonella enteritidis. A prospective matched study, 30 patients positive for Salmonella enteritidis, 16% exhibited increased serum lipase levels, however no pancreatic changes

It is even more unique to be diagnosed in an immune-competent young patient. While in the hospital patient was diagnosed with acute pancreatitis by meeting two criteria, elevated amylase and lipase and radiologic imaging. Although not clear, his presentation could have been a new onset acute pancreatitis in the setting of salmonella bacteremia or an exacerbation of previously resolving pancreatitis. Pancreatitis associated with salmonella enteritidis can result from hematogenous spread of bacteria either from the broken barrier of the intestinal mucosa, or given that literature suggests growth of bacteria in bile and gallstone cultures. Contiguously spread of infection within the biliary duct is also possible. Serum amylase rises within 6 to 12 hours of the onset of acute pancreatitis. Serum lipase rises within 4 to 8 hours of the onset of symptoms, peaks at 24 hours, and returns to normal within 8 to 14 days. Although our patient did consume alcohol few days before presentation, a negative alcohol screen and normal pancreatic enzymes on presentation make alcohol a less likely offender. Interestingly, since pancreatitis developed after patient tested positive for salmonella bacteremia, it seems the likely cause of pancreatitis.

CONCLUSION

Although a rare complication, patients being treated for salmonella bacteremia should be monitored for acute pancreatitis, especially when alcohol consumption is reported in past history. Simple providers’ mindfulness, an inexpensive test and supportive treatment may decrease morbidity and mortality in patients with Salmonella associated