What is beyond Salmonella gastroenteritis? A case of acute pancreatitis complicating Salmonella infection in a child: A case report and literature review

Salmonella infection presents itself in a wide variety of ways, ranging from mild self-limit to severe systemic disease with multiorgan involvement. Acute pancreatitis (AP) is a very rare complication associated with Salmonella infection, especially among the pediatric population. Although abdominal pain is a common presentation of Salmonella infection, the possibility is considered when the pain is severe and the characteristics of the pain are suggestive of AP. Herein, a case of AP complicating Salmonella infection in an immunocompetent child is reported.

  • Fever, vomiting, watery diarrhoea and severe abdominal pain in the epigastric area
  • The pain was relieved by passing stool
  • The pain was aggravated by food intake
  • Abdominal distension – No
  • Recent travel – No
  • Febrile, tachycardia with moderate dehydration
  • Vital signs – normal
  • Complete blood count, renal function, electrolyte level, urine cultures – normal
  • Bicarbonate level – low
  • Rapid antigen detection test – positive for Group A streptococcal infection

The patient was admitted with a suspected Group A streptococcal infection and was initiated with intravenous (IV) hydration and penicillin G sodium treatment

  • Abdominal examination: severe tenderness and pain localized to the epigastric area
  • Fever: > 39°C
  • Diarrhoea: worsen, tenesmus
  • Tachycardic with normal blood pressure
  • Treatment: IV paracetamol and NSAIDs
  • C-reactive protein, amylase and lipase levels: Elevated
  • Renal and liver function parameters: Normal
  • Bicarbonate level: Improved
  • Abdominal ultrasound - free fluid: ~20 mL in the left lower abdomen
  • The patient was treated as a case of acute pancreatitis following the standard protocol and IV analgesia
  • Antibiotic treatment was upgraded from penicillin to piperacillin-tazobactam
  • Abdominal pain: Severe 
  • Abdominal ultrasound: Fluid pocket 
  • Abdominal X-ray: Gas distension of the transverse colon
  • C-reactive protein, amylase and lipase levels: Elevated
  • Treatment: IV morphine and omeprazole
  • Abdominal pain and diarrhoea: Improved
  • Stool culture: Positive for Salmonella Group B
  • C-reactive protein and lipase levels: Improved

The patient was discharged with a full recovery and close follow-up

  • Amylase levels: Improved
  • Ultrasound: Complete resolution of the fluid pockets
  • Toxin-induced or immune-mediated or direct penetration or spread of salmonellae into the pancreas is considered the probable cause of pancreatitis.
  • Most of the cases of salmonella gastroenteritis are characterized by elevated serum amylase and lipase without clinical correlation to acute pancreatitis.
  • In the pediatric population, acute pancreatitis though a rare complication of a salmonella infection should be considered a possibility in patients presenting with severe abdominal pain.
  • Timely diagnosis and treatment will lead to a decrease in mortality and morbidity rates associated with Salmonella infection.

NSAIDs - nonsteroidal anti-inflammatory drugs

    1. Al Kaabi S, Al Kaabi A, Al Nuaimi H. What is beyond Salmonella gastroenteritis? A case of acute pancreatitis complicating Salmonella infection in a child: a case report and literature review. BMC Pediatr. 2021 Aug 17;21(1):353. Availbale at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369656/

MAT-IN-2201504 06/22