Sequential infection of walled-off pancreatic necrosis by Salmonella Typhi with secondary Enterococcus avium superinfection following ERCP: A case report.

Infected pancreatic necrosis is a major determinant of morbidity in acute pancreatitis and is usually caused by enteric flora. Isolation of Salmonella enterica serovar Typhi from pancreatic necrosis is exceptionally rare, and secondary superinfection by Enterococcus avium is even more uncommon. We report a middle-aged male who developed walled-off pancreatic necrosis following ERCP for gallstone disease. Initial drainage yielded S. Typhi. Persistent sepsis prompted repeat culture, which isolated E. avium, indicating sequential superinfection within the same cavity. This case highlights the importance of serial cultures and vigilance for unusual pathogens in post-procedural pancreatic infections.