SPONTANEOUS BACTERIAL PERITONITIS (SBP) IN ASCITES DUE TO ADVANCED PANCREATIC ADENOCARCINOMA IN THE ABSENCE OF CHRONIC LIVER DISEASE

We present the case of an 82-year-old woman diagnosed with pancreatic adenocarcinoma with hepatic metastases and no history of liver disease. She presented to the hospital with fever (38 ºC) and abdominal distension with no pain. A therapeutic paracentesis was performed, draining 3,500 mL of cloudy whitish ascitic fluid. The analytical findings were consistent with spontaneous bacterial peritonitis (SBP) and portal hypertension (PH). Blood tests showed leukocytosis (21,300 leukocytes/μL), C-reactive protein 13 mg/dL, and procalcitonin 0.62 ng/mL. She also had known chronic cholestasis of neoplastic origin. Escherichia coli was isolated in both blood cultures and ascitic fluid culture. Abdominal ultrasound showed a neoplasm in the pancreatic head with a metallic biliary stent, numerous hepatic metastases, and moderate ascites. The portal and hepatic veins were patent and of preserved caliber. There was no splenomegaly or collateral circulation. No additional indirect or invasive studies were performed for assessment of PH. She was treated with intravenous ceftriaxone 2 g daily for 7 days with clinical and analytical improvement. In the follow-up paracentesis, less turbid yellowish fluid was drained with analytical remission. The patient was discharged for continued follow-up by home palliative care and died three weeks later.