Description

Pancreas cancer with peritoneal involvement was found in a 64-year-old man for which he received 5-fluorouracile, folinic acid and oxaliplatin.

One month later, the patient was referred to ICU for shock. Examination revealed intense abdominal and right scrotal pain. The patient received fluids, norepinephrine and intravenous piperacillin-tazobactam.

Abdominal CT-scan (Figure 1) disclosed peritoneal effusion, colonic mucosal thickening and a right hydrocele containing mild pneumoscrotum but no pneumo peritoneum.

Laparotomy found an abundant serous peritoneal effusion without ischemia. Scrototomy revealed an hematic fluid associated with epididymo-orchitis requiring orchidectomy. Scrotal, peritoneal samples and blood cultures performed at admission grew with wild Klebsiella aerogenes strain. The patient’s status rapidly worsened and he died three days after surgery.

Microbiological samples grew a wild Klebsiella aerogenes producing gas (Figure 2).

Enterobacter aerogenes, recently renamed Klebsiella aerogenes is responsible for bacteremia, intrabdominal and genitourinary infections, carrying significant mortality.

As indicated by his name, Klebsiella aerogenes is able to produce significant amount of gas.

Declarations

Data availability: Not applicable.

Funding source: None.

Contributions: VB, SBD and EM were in charge of the patient. RD conducted the microbiogical work-up. All authors contributed equally to writing and editing the manuscript.

Conflicts of interest: There is no conflict of interest to declare.