Acute Calculous Cholecystitis Associated with Leptospirosis: Which is the Emergency? A Case Report and Literature Review
, , , , , , , and
Jul 31, 2024
About this article
Article Category: Case Report
Published Online: Jul 31, 2024
Page range: 271 - 278
Received: Mar 11, 2024
Accepted: Jul 12, 2024
DOI: https://doi.org/10.2478/jccm-2024-0033
Keywords
© 2024 Renata Moriczi et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Changes in the patient’s laboratory parameters during hospitalization and six weeks after discharge
| Leucocyte (×103/μL) | 9.61 | 8.79 | 6.08 | 5.69 | 10.90 | 16.60 | 10.32 | 6.42 |
| Neutrophils (%) | 89.70 | 86.80 | 89 | 83 | 78 | 78.7 | 80.10 | 57.6 |
| Lymphocyte (%) | 6.61 | 6.63 | 0.27 | 9.40 | 0.98 | 8.34 | 1.10 | 34.3 |
| Hemoglobin (g/dL) | 14.10 | 12.4 | 10.40 | 10.80 | 12.60 | 14.00 | 12.3 | 14.2 |
| Hematocrit (%) | 42.60 | 36.4 | 30.10 | 31.90 | 37.80 | 41.50 | 34.7 | 44.6 |
| Thrombocyte (×103/μL) | 155.00 | 28.5 | 14.00 | 12.90 | 31.60 |
28.90 |
130.00 | 241.00 |
| AST (U/L) | 25.00 | 75.00 | 78.00 | 123.00 | 48.00 | 45.60 | 91.80 | 24.00 |
| ALT (U/L) | 22.00 | 47.00 | 50.00 | 88.00 | 29.00 | 15.00 | 43.30 | 74.00 |
| Total Bilirubin (mg/dL) | 1.37 | 5.01 | 5.44 | 5.43 | 9.67 | 7.38 | 5.89 | 0.79 |
| Direct Bilirubin (mg/dL) | - | 4.14 | - | - | - | 7.13 | 4.69 | 0.29 |
| C-Reactive Protein (mg/dL) | 143.20 | 291.40 | 252.30 | - | - | 139.00 | 71.60 | - |
| Urea (mg/dL) | 34.24 | 115.56 | 128.40 | 186.18 | 196.88 | 169.00 | 104.00 | 53.00 |
| Creatinine (mg/dL) | 1.26 | 4.68 | 5.51 | 6.56 | 5.65 | 3.55 | 1.61 | 1.27 |
| Calculated RFG (ml/min) | 60.35 | 13.31 | 11.03 | 9.02 | 10.71 | 17.26 | 42.99 | 57.00 |
| Amylase U/L | 50.00 | 89.00 | - | 432.00 | 232.00 | 453.00 | 439.00 | 74.00 |
Ten cases of acute acalculous cholecystitis as a complication of leptospirosis [2, 4, 8,9,10,11,12,13,14]
| Age | 19 | 46 | 35 | - | 30 | 64 | 55 | 40 | 83 | 45 |
| Sex | F | F | F | M | M | M | M | M | M | F |
| Country | Brazil | New Zealand | Netherlands | Netherlands | India | Greece | Spain | India | Malaysia | Turkey |
| Right hypochondrium or abdominal pain | Yes | Yes | Yes | Yes | yes | Yes | Yes | Yes | Yes | Yes |
| Jaundice | No | No | No | No | Yes | No | Yes | No | No | No |
| White blood cell number (×103/μL) | 7.7 | 2.0 | 10.90 | 4.4 | ND | 14.00 | 27.1 | 12.30 | 11.70 | 7.30 |
| Total bilirubin (mg/dL) | ND | ND | 48 | 34 | 2.1 | 3.1 | 12.4 | 3.9 | 0.91 | 0.3 |
| IgM titer | ND | ND | ND | ND | Unequivocally positive | Strongly positive | Positive | Positive | Positive | Positive |
| Thrombocytopenia (/μL) | Yes (145,000) | Yes (84,000) | No (121,000) | No (121,000) | Yes (65,000) | Yes (95,000) | Yes (57,000) | Yes (85,000) | No (169,000) | No (316,000) |
| Imaging modalities | Abdominal ultrasound and CT | Abdominal ultrasound and MRCP | Abdominal ultrasound | Abdominal ultrasound | Abdominal ultrasound | Abdominal ultrasound and CT | CT | Abdominal ultrasound | CT | Abdominal ultrasound |
| Imaging findings for acute cholecystitis | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes |
| Gallbladder stones | AAC | AAC | AAC | AAC | AAC | AAC | AAC | ACC | ACC | ACC |
| Renal failure | No | No | No | No | No | Yes | Yes | Yes | Yes | No |
| Associated pancreatitis or pancreatic reaction | No | No | no | No | No | No | No | No | Yes | No |
| Treatment | Antibiotics | Antibiotics | Antibiotics | Antibiotics | Antibiotics and open cholecystectomy | Antibiotics and open cholecystectomy | Antibiotics | Antibiotics | Antibiotics | Antibiotics |
| Complications | Pneumonia, Pericarditis | - | Pneumonia | Pneumonia | - | Chronic renal failure | Multiorgan failure, death | - | - | - |