TORULOPSIS GLABRATA-INFECTED PANCREATIC PSEUDOCYSTS - DIAGNOSIS AND TREATMENT

Torulopsis glabrata, a fungus commensal with the human gastrointestina l tract, so far has not been recognized as a cause of pancreatic sepsi s. We report the cases of two patients with pancreatic pseudocysts tha t became infected with;T: glabrata. A 20-year-old woman 6 weeks postpa rtum had acute gallstone pancreatitis complicated by pseudocyst format ion and pancreatic sepsis. Pseudocyst fluid obtained at cystogastrosto my showed a pure culture of T: glabrata. A 52-year-old man with multip le medical problems showed signs of an infected pseudocyst 9 days afte r he was hospitalized for alcoholic pancreatitis. Computed tomography (CT)-guided aspiration of the pseudocyst fluid confirmed T glabrata as the infecting organism. Neither patient had a history of endoscopic o r surgical manipulation. Prolonged therapy with broad-spectrum antibio tics and parenteral hyperalimentation were implicated as risk factors, and other possible pathogenic mechanisms were considered. Both patien ts were treated successfully with a combination of percutaneous or sur gical drainage and amphotericin B, which appears to be the most active drug in vitro. The efficacy of other antifungal agents is discussed, In the context of pancreatitis and/or pseudocysts, empiric therapy wit h broad-spectrum antibiotics should be minimized because it predispose s patients to superinfection by opportunistic pathogens.