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Acalculous Cholecystitis Presenting as a Septic Joint: A Case Report
Yousaf Zafar1, Ahmed A Elkafrawy1, Julie Nahar2
1Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA.
Cureus
|October 1, 2019
Summary
Acalculous cholecystitis, rare outside the abdomen, was diagnosed in a patient with a prosthetic knee infection. This case highlights the importance of considering gallbladder issues in unusual presentations.
Area of Science:
- Gastroenterology
- Infectious Disease
- Orthopedic Surgery
Background:
- Acalculous cholecystitis typically presents with abdominal pain, making extra-abdominal presentations rare and diagnostically challenging.
- Infectious processes can disseminate, leading to secondary complications in distant sites, such as the gallbladder.
Observation:
- A 77-year-old male with a history of left knee arthroplasty presented with left knee pain and swelling.
- Cultures from knee arthrocentesis revealed *Clostridium perfringens*, prompting an investigation for the primary infection source.
- Initial imaging revealed gallbladder sludge without typical signs of acute cholecystitis, but CT and HIDA scans confirmed acalculous cholecystitis.
Findings:
- The patient's gallbladder infection was confirmed to be caused by *Clostridium perfringens*, originating from the septic prosthetic joint.
- Successful treatment involved biliary drainage, antibiotics (ertapenem and moxifloxacin), and surgical management of the prosthetic joint infection.
- The patient's symptoms resolved completely after cholecystectomy.
Implications:
- This case underscores the need to consider acalculous cholecystitis in patients with unexplained symptoms, particularly those with prosthetic joint infections.
- Early and accurate diagnosis through a combination of imaging and microbiological cultures is crucial for effective management.
- A multidisciplinary approach involving gastroenterology, infectious disease, and orthopedic surgery is essential for managing complex cases with disseminated infections.
