{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T22:28:38Z","timestamp":1768948118237,"version":"3.49.0"},"reference-count":27,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Fungal infection of pancreatic fluid collections (PFCs) in severe acute pancreatitis (SAP) is under-recognized and associated with poor outcomes. Overlap with bacterial infections and the need for invasive sampling often delay diagnosis, leading to prolonged antibiotic use without the use of antifungal agents. Methods: We report three cases of SAP complicated by fungal infection of PFCs. Two patients, one with alcohol-related pancreatitis and the other with biliary pancreatitis, developed symptomatic encapsulated necrosis. Both were successfully managed with endoscopic drainage and targeted antifungal therapy against Candida albicans, achieving full resolution. The third patient, with necrotizing biliary pancreatitis, underwent multiple surgical and endoscopic interventions and developed an infection with a non-albicans Candida species. Reduced susceptibility requires individualized antifungal adjustment guided by susceptibility testing. Despite aggressive multimodal therapy, the patient progressed to multiorgan failure and died subsequently. Results: These cases emphasize the clinical impact of fungal infections in patients with SAP, particularly their association with severe disease, prolonged hospitalization, and prior antibiotic exposure. These findings highlight the prognostic value of early microbiological sampling, species-level identification, and prompt initiation of antifungal therapy. Infections caused by non-albicans species pose additional challenges due to their reduced sensitivity to standard antifungal agents. Conclusions: Fungal infection of PFCs is a clinically significant and frequently underestimated complication of SAP. Early recognition and species-directed antifungal therapy are critical for improving outcomes in high-risk patients.<\/jats:p>","DOI":"10.3390\/jcm15020790","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:24:34Z","timestamp":1768901074000},"page":"790","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fungal Infections in Severe Acute Pancreatitis: Insights from a Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Andreea","family":"Iacob","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2919-4940","authenticated-orcid":false,"given":"Gheorghe G.","family":"Balan","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology, St. Spiridon Iasi County Emergency Clinical Hospital, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8694-6037","authenticated-orcid":false,"given":"Mihaela","family":"Blaj","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, St. Spiridon Iasi County Emergency Clinical Hospital, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adi-Ionut","family":"Ciumanghel","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, St. Spiridon Iasi County Emergency Clinical Hospital, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6206-6126","authenticated-orcid":false,"given":"Vasile","family":"Sandru","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, School of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7783-1203","authenticated-orcid":false,"given":"Elena","family":"Toader","sequence":"additional","affiliation":[{"name":"Institute of Gastroenterology and Hepatology, St. Spiridon Iasi County Emergency Clinical Hospital, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20142012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1053\/j.gastro.2018.11.031","article-title":"An endoscopic transluminal approach, compared with minimally invasive surgery, significantly reduced major complications in infected necrotizing pancreatitis","volume":"156","author":"Bang","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1159\/000067684","article-title":"IAP Guidelines for the surgical management of acute pancreatitis","volume":"2","author":"Uhl","year":"2002","journal-title":"Pancreatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1001\/archsurg.136.5.592","article-title":"Pancreatic Infection in Severe Pancreatitis: The Role of Fungus and Multiresistant Organisms","volume":"136","author":"Gloor","year":"2001","journal-title":"Arch. 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