case_images: PMC10849867_01
case_images: Chest and abdominal CT scans on admission. (A) Chest CT scan shows bilateral ground-glass opacities and consolidation in both lungs. (B) Abdominal CT scan reveals normal gall bladder and biliary tract, with unremarkable pancreas. CT: computed tomography
case_images: cureus-0016-00000051889-i01.jpg
case_images: PMC10849867_01_cureus-0016-00000051889-i01.jpg
case_images: FIG1
case_images: Computed tomography (CT) revealed bilateral ground-glass opacities and consolidation in both lungs (Figure 1A) and a normal gall bladder and biliary tract, with an unremarkable pancreas (Figure 1B).
case_images: Clinical course after admission. Although the respiratory and renal impairments gradually improved, high-grade fever persisted until treatment for WON was initiated. MCFG: micafungin; MEPM: meropenem; mPSL: methylprednisolone; PSL: prednisolone; WON: walled-off necrosis
case_images: cureus-0016-00000051889-i02.jpg
case_images: PMC10849867_01_cureus-0016-00000051889-i02.jpg
case_images: FIG2
case_images: Additionally, the patient developed acute kidney failure and required hemodialysis (Figure 2). The patient was weaned from hemodialysis on day 32 and received ventilation on day 39 (Figure 2).
case_images: Abdominal CT scans at diagnosis of WON. CT scans of the abdomen show a heterogenous collection showing liquid and non-liquid components with a well-defined wall around the pancreas (white arrow). CT: computed tomography, WON: walled-off necrosis
case_images: cureus-0016-00000051889-i03.jpg
case_images: PMC10849867_01_cureus-0016-00000051889-i03.jpg
case_images: FIG3
case_images: However, the high-grade fever persisted, and abdominal CT demonstrated a heterogenous collection showing liquid and non-liquid components with a well-defined wall around the pancreas (Figure 3), leading to the diagnosis of WON.
case_images: Changes in abdominal CT scans after initiation of treatment for WON. (A) Endoscopic ultrasound-guided transgastric drainage using a lumen-apposing metal stent did not improve encapsulated collection significantly (day 98). (B) A follow-up CT after endoscopic necrosectomy shows marked improvement in the encapsulation collection (day 195). CT: computed tomography, WON: walled-off necrosis
case_images: cureus-0016-00000051889-i04.jpg
case_images: PMC10849867_01_cureus-0016-00000051889-i04.jpg
case_images: FIG4
case_images: However, the encapsulated collection did not improve significantly (Figure 4A). A follow-up CT showed that the encapsulation collection remained improved (Figure 4B).