Leptospirosis – A Rare Cause of Acute Acalculous Cholecystitis: Successfully Treated with Antibiotics and Cholecystectomy
Hemanth Kilaru
Department of Internal Medicine, PIMS, Karimnagar, Telangana, India.
Satish Chandra Kilaru *
Department of Pulmonology, PIMS, Karimnagar, Telangana, India.
John Israel Pulukuri
Department of Internal Medicine, PIMS, Karimnagar, Telangana, India.
Chandrika Reddy Abbadi
Department of Surgery, PIMS, Karimnagar, Telangana, India.
Venkat Mohan Reddy Abbadi
Department of Surgery, PIMS, Karimnagar, Telangana, India.
*Author to whom correspondence should be addressed.
Abstract
Aim: Leptospirosis is a rare cause of Acute acalculous cholecystitis (AAC), reported as a presenting feature, hitherto. The present report suggests that it can complicate leptospirosis during its treatment and rapidly deteriorate warranting prompt surgical intervention. The aim of this case report is to consider leptospirosis in evaluation of acute febrile illness and be vigilant for the possibility of AAC.
Presentation of Case: We present a case of 30-year old male driver with Leptospirosis, complicated with AAC during the inpatient period of management. Diagnosis of Leptospirosis was made based on fulfilment of modified Faine’s criteria & unequivocally positive IgM (ELISA) titers for Leptospirosis and was managed with antibiotics. During the inpatient period, however, the patient developed signs of AAC for which he underwent cholecystectomy during which gangrene of the gallbladder was noted. He showed complete recovery and was doing well during the three months of follow up.
Discussion: Leptospirosis is a rare cause of AAC and the latter has the propensity for progressing to gangrene and perforation and might go undiagnosed unless a high index of suspicion is shown. Hence, prompt and aggressive management with antibiotics and surgery when needed (as in our case) is imperative.
Conclusion: A high index of suspicion of leptospirosis in a patient with acute febrile illness, especially in tropics and constant vigil for the said complication, apart from personal hygiene and preventive public health measures will not only prevent such infections but also reduce associated morbidity and mortality.
Keywords: Leptospirosis, Weil’s disease, acute acalculous cholecystitis, cholecystectomy