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Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report

It is rare for acalculous cholecystitis to present with symptoms outside the abdomen; hence, making its diagnosis can be a challenge. We report a case of a 77-year-old male, with a relevant past medical history of left knee arthroplasty two years prior, who presented with left knee pain and swelling...

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Autores principales: Zafar, Yousaf, Elkafrawy, Ahmed A, Nahar, Julie, Shafiq, Muhammad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759001/
https://www.ncbi.nlm.nih.gov/pubmed/31565600
http://dx.doi.org/10.7759/cureus.5193
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author Zafar, Yousaf
Elkafrawy, Ahmed A
Nahar, Julie
Shafiq, Muhammad
author_facet Zafar, Yousaf
Elkafrawy, Ahmed A
Nahar, Julie
Shafiq, Muhammad
author_sort Zafar, Yousaf
collection PubMed
description It is rare for acalculous cholecystitis to present with symptoms outside the abdomen; hence, making its diagnosis can be a challenge. We report a case of a 77-year-old male, with a relevant past medical history of left knee arthroplasty two years prior, who presented with left knee pain and swelling. Cultures from the arthrocentesis grew Clostridium perfringens, which led to a search for the source of infection. The right upper quadrant (RUQ) ultrasound (US) showed an enlarged gallbladder filled with sludge, but no cholelithiasis or secondary ultrasound findings were present to suggest acute cholecystitis. A computed tomography (CT) scan showed a distended gallbladder with diffuse gallbladder wall thickening and no stone but with suspicion for acalculous cholecystitis. A subsequent hepatobiliary (HIDA) scan confirmed the diagnosis of acalculous cholecystitis. Subsequently, the patient had a biliary drain placed. Bile cultures grew gram-positive rods consistent with Clostridium perfringens, confirming the source. With regards to the septic prosthetic joint, the patient underwent irrigation and debridement with polyethylene exchange without replacement of the prosthesis. The patient was also treated with six weeks of intravenous (IV) ertapenem (1 gram daily) and 12 months of moxifloxacin (400 mg daily). He had a cholecystectomy later and his symptoms were completely resolved.
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spelling pubmed-67590012019-09-28 Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report Zafar, Yousaf Elkafrawy, Ahmed A Nahar, Julie Shafiq, Muhammad Cureus Internal Medicine It is rare for acalculous cholecystitis to present with symptoms outside the abdomen; hence, making its diagnosis can be a challenge. We report a case of a 77-year-old male, with a relevant past medical history of left knee arthroplasty two years prior, who presented with left knee pain and swelling. Cultures from the arthrocentesis grew Clostridium perfringens, which led to a search for the source of infection. The right upper quadrant (RUQ) ultrasound (US) showed an enlarged gallbladder filled with sludge, but no cholelithiasis or secondary ultrasound findings were present to suggest acute cholecystitis. A computed tomography (CT) scan showed a distended gallbladder with diffuse gallbladder wall thickening and no stone but with suspicion for acalculous cholecystitis. A subsequent hepatobiliary (HIDA) scan confirmed the diagnosis of acalculous cholecystitis. Subsequently, the patient had a biliary drain placed. Bile cultures grew gram-positive rods consistent with Clostridium perfringens, confirming the source. With regards to the septic prosthetic joint, the patient underwent irrigation and debridement with polyethylene exchange without replacement of the prosthesis. The patient was also treated with six weeks of intravenous (IV) ertapenem (1 gram daily) and 12 months of moxifloxacin (400 mg daily). He had a cholecystectomy later and his symptoms were completely resolved. Cureus 2019-07-22 /pmc/articles/PMC6759001/ /pubmed/31565600 http://dx.doi.org/10.7759/cureus.5193 Text en Copyright © 2019, Zafar et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Zafar, Yousaf
Elkafrawy, Ahmed A
Nahar, Julie
Shafiq, Muhammad
Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report
title Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report
title_full Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report
title_fullStr Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report
title_full_unstemmed Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report
title_short Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report
title_sort acalculous cholecystitis presenting as a septic joint: a case report
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759001/
https://www.ncbi.nlm.nih.gov/pubmed/31565600
http://dx.doi.org/10.7759/cureus.5193
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