A 48-year-old woman with chronic ethylic pancreatitis presented with new onset of fever, dysphagia, and elevated inflammatory parameters. Computed tomography revealed a large cystic supradiaphragmatic paraesophageal structure and two small retroperitoneal cysts near the pancreatic body. Transesophageal endosonographic fine-needle aspiration showed pus and an elevated amylase level. The diagnosis of an infected pancreatic pseudocyst was made. Consequently, a 10 Fr double-pigtail catheter and a 7 Fr nasocystic tube were inserted transesophageally. Infection was treated with intravenous penicillin according to antimicrobial resistance of the detected Streptococcus anginosus.
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Magdeburg et al. (2017) studied this question.