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.

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