Ye QinHao Jonathan, Desai Suneel Ramesh, Tan Ek Khoon
General Medicine, Sengkang General Hospital, Singapore, SGP.
Anaesthesiology, Singapore General Hospital, Singapore, SGP.
Cureus. 2018 Jun 22;10(6):e2864. doi: 10.7759/cureus.2864.
We describe a case of melioidosis presenting as acalculous cholecystitis in a middle-aged Chinese male. The patient presented with clinical features of cholecystitis and computed tomography (CT) imaging did not reveal other obvious sources of sepsis other than acalculous cholecystitis. The decision was made by the hepatobiliary team to proceed with an urgent cholecystectomy in view of patient's septic presentation. Cultures from peripheral blood and intraoperatively obtained bile fluid grew The patient subsequently completed one month of meropenem, followed by another three months of eradication therapy. The patient denied soil contact in his work but he comes from a melioidosis-endemic country. He was also newly diagnosed with diabetes mellitus during his admission. We believe this to be the first reported case of melioidosis presenting as acalculous cholecystitis with a positive bile fluid culture. Urgent cholecystectomy in susceptible cases, with positive contact history or from endemic countries, might present another modality to achieve source control. Appropriate antibiotics with melioidosis coverage should be started early as well.
我们描述了一例在一名中年中国男性中表现为无结石性胆囊炎的类鼻疽病病例。患者表现出胆囊炎的临床特征，计算机断层扫描（CT）成像未发现除无结石性胆囊炎外的其他明显脓毒症来源。鉴于患者的脓毒症表现，肝胆外科团队决定进行紧急胆囊切除术。外周血和术中获取的胆汁液培养结果显示……患者随后完成了一个月的美罗培南治疗，接着进行了另外三个月的根除治疗。患者否认工作中接触过土壤，但他来自一个类鼻疽病流行国家。他在入院期间还被新诊断出患有糖尿病。我们认为这是首例报告的以无结石性胆囊炎表现且胆汁液培养呈阳性的类鼻疽病病例。对于有易感性、有阳性接触史或来自流行国家的病例，紧急胆囊切除术可能是实现源头控制的另一种方式。同时也应尽早开始使用覆盖类鼻疽病的适当抗生素。
