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      Acute Necrotizing Pancreatitis Associated with Mycoplasma pneumoniae Infection in a Child

      case-report

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          Abstract

          Mycoplasma pneumoniae is responsible for approximately 20% to 30% of community-acquired pneumonia, and is well known for its diverse extrapulmonary manifestations. However, acute necrotizing pancreatits is an extremely rare extrapulmonary manifestation of M. pneumoniae infection. A 6-year-old girl was admitted due to abdominal pain, vomiting, fever, and confused mentality. Acute necrotizing pancreatitis was diagnosed according to symptoms, laboratory test results, and abdominal computed tomography scans. M. pneumoniae infection was diagnosed by a 4-fold increase in antibodies to M. pneumoniae between acute and convalescent sera by particle agglutination antibody assay. No other etiologic factors or pathogens were detected. Despite the occurrence of a large infected pseudocyst during the course, the patient was able to discharge without morbidity by early aggressive supportive care. This is the first case in Korea of a child with acute necrotizing pancreatitis associated with M. pneumoniae infection.

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          Treatment of severe acute pancreatitis and its complications.

          Enver Zerem (2014)
          Severe acute pancreatitis (SAP), which is the most serious type of this disorder, is associated with high morbidity and mortality. SAP runs a biphasic course. During the first 1-2 wk, a pro-inflammatory response results in systemic inflammatory response syndrome (SIRS). If the SIRS is severe, it can lead to early multisystem organ failure (MOF). After the first 1-2 wk, a transition from a pro-inflammatory response to an anti-inflammatory response occurs; during this transition, the patient is at risk for intestinal flora translocation and the development of secondary infection of the necrotic tissue, which can result in sepsis and late MOF. Many recommendations have been made regarding SAP management and its complications. However, despite the reduction in overall mortality in the last decade, SAP is still associated with high mortality. In the majority of cases, sterile necrosis should be managed conservatively, whereas in infected necrotizing pancreatitis, the infected non-vital solid tissue should be removed to control the sepsis. Intervention should be delayed for as long as possible to allow better demarcation and liquefaction of the necrosis. Currently, the step-up approach (delay, drain, and debride) may be considered as the reference standard intervention for this disorder.
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            Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible?

            Veronique Morinville, M. Michael Barmada, David Lowe (2009)
            Studies show an increased incidence of adult acute pancreatitis (AP) in recent decades. The aim was to review pediatric AP incidence. Retrospective review of computerized databases at the Children's Hospital of Pittsburgh from 1993 to 2004. The International Classification of Diseases, Ninth Revision, code 5770 Acute Pancreatitis was used; results were tabulated by discharge year and month. The incidence of AP was compared with orders for amylase and lipase testings and with the catchment population. Over the study period, there were a total of 1021 discharge diagnoses of AP (731 first diagnoses). The diagnosis of AP increased from a low of 28 total cases (21 first diagnoses) in 1993 to a high of 141 total cases (109 first diagnoses) in 2004. The catchment population decreased from 882,000 to 826,500. The estimated incidences of first AP admission were 2.4 to 13.2 per 100,000 children (years 1993-2004; r = 0.8339). Linear regression analysis suggests that increased testing for amylase and lipase could account for 94% of the change in all AP admissions (P = 5.1 x 10). The increased incidence of AP at the Children's Hospital of Pittsburgh from 1993 to 2004 may have been primarily driven by increased testing for the disease.
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              Pancreatitis in children.

              Subra Kugathasan, S Werlin, Brenda Frautschy (2003)
              To determine the incidence, etiology and outcome of pancreatitis at a regional children's hospital. Chart review of all patients with pancreatitis seen during a 6 year period at the Children's Hospital of Wisconsin. The diagnosis of pancreatitis required either a serum amylase or lipase >3 times normal or radiographic evidence of pancreatitis. Two hundred fourteen episodes of pancreatitis in 180 patients were documented. The most common etiologies were systemic disease (14%), trauma (14%), drug induced (12%), biliary tract disease (12%), infectious (8%), and idiopathic (8%), which made up 68% of the total cases. Eleven patients died, all from underlying systemic illnesses. The serum amylase and lipase were elevated in 82% and 83% of patients respectively. Pancreatitis is more common in children than previously thought. Upon careful assessment fewer cases were found to be idiopathic than in previous series. The outcome of pancreatitis depends on co-morbid conditions.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pediatr Gastroenterol Hepatol Nutr
                Journal ID (iso-abbrev): Pediatr Gastroenterol Hepatol Nutr
                Journal ID (publisher-id): PGHN
                Title: Pediatric Gastroenterology, Hepatology & Nutrition
                Publisher: The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
                ISSN (Print): 2234-8646
                ISSN (Electronic): 2234-8840
                Publication date (Print): September 2015
                Publication date (Electronic): 25 September 2015
                Volume: 18
                Issue: 3
                Pages: 209-215
                Affiliations
                Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [* ]Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [† ]Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                Author notes
                Corresponding author: Yon Ho Choe, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-3527, Fax: +82-2-3410-0043, i101016@ 123456skku.edu
                Article
                DOI: 10.5223/pghn.2015.18.3.209
                PMC ID: 4600707
                PubMed ID: 26473143
                SO-VID: 1dbe1fbe-d08e-4d9c-840f-a283020f3cc9
                Copyright © Copyright © 2015 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 January 2015
                Date accepted : 24 February 2015
                Categories
                Subject: Case Report

                Keywords: mycoplasma pneumoniae,pancreatitis,acute necrotizing
                Data availability:
                Keywords: mycoplasma pneumoniae, pancreatitis, acute necrotizing

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