Acute acalculous cholecystitis - Salmonella

Discussion:

Acalculous cholecystitis typically affects critically ill hospital patients and has a high morbidity and mortality: gall bladder stasis and ischemia often lead to perforation and/or secondary infection. Percutaneous cystostomy can be diagnostic and therapeutic.

This case is unusual: a fit 25 year old developed florid acalculous cholecystitis 10 days after developing severe diarrhea. Fecal cultures were 4+ for Salmonella. Disease is normally self-limiting and antibiotics are reserved for complications or for immunosuppressed patients.

Salmonella can spread through blood, bile or lymph. Extra-intestinal complications include endocarditis, vascular infections including aortitis, hepatic and splenic abscesses, urinary tract infections, pneumonia or empyema, meningitis, septic arthritis and osteomyelitis.

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