Acute cholecystitis secondary to dog bite.

INTRODUCTION

The gram-negative bacteria known as Capnocytophaga canimorsus (C. canimorsus) is found in dog saliva and rarely can cause severe infection in humans following a bite or scratch. There has previously been just a single case described in the literature of Acute Acalculous Cholecystitis (AAC) secondary to C. canimorsus.

PRESENTATION OF CASE

Here we describe the second ever published case of C. canimorsus bacteremia presenting with acute cholecystitis. The patient presented with epigastric pain and sepsis three weeks post domestic dog bite. On further examination, he was Murphy's sign positive. Investigations included blood cultures, Ultrasound Scan and Computed Tomography of the Abdomen. He was treated with intravenous fluid resuscitation, and intravenous ceftriaxone and metronidazole. He required an extended course of antibiotics for complete symptom resolution. His blood cultures were positive for C. Canimorsus.

DISCUSSION

This case highlights the ever-present need for thorough history and examination, and consideration of prolonged antibiotics for cases of cholecystitis that could be secondary to C. canimorsus bacteremia.

CONCLUSION

We strongly advocate blood cultures in patients who present with abdominal pain and sepsis, particularly when they have a recent history of animal bite. In cases of cholecystitis secondary to C. canimorsus it may be necessary to monitor the patient's progress more closely and treat with prolonged targeted antibiotic therapy.