A rare case of Streptococcus pneumoniae infection in a giant pancreatic pseudocyst

BACKGROUND: Pancreatic pseudocysts are known sequelae of acute and chronic pancreatitis and are typically sterile. Superinfection is not uncommon, but isolation of Streptococcus pneumoniae is exceedingly rare. CASE PRESENTATION: We report a 32-year-old immunocompetent male with a background of chronic alcohol-related pancreatitis presenting with worsening abdominal pain and early satiety. Imaging revealed a large pseudocyst. Laparoscopic transgastric cystogastrostomy with cholecystectomy was performed, and culture of aspirated cyst fluid yielded Streptococcus pneumoniae. The patient recovered uneventfully on targeted antibiotic therapy. CONCLUSION: This case illustrates the importance of microbiological evaluation of pseudocyst fluid and highlights an unusual presentation of S. pneumoniae superinfection in a pancreatic pseudocyst.