A 66-year-old man with uncontrolled diabetes (hemoglobin A1c of 13) presented with 1 week of malaise and upper back pain. He was diagnosed with paraspinal pyomyositis and bacteremia due to methicillin-susceptible Staphylococcus aureus (MSSA). He underwent multiple back surgical debridements. On hospital day 7, he had persistent MSSA bacteremia and leukocytosis despite appropriate antibiotics. Examination revealed persistent back purulence and a right upper quadrant tender mass 6 cm below the costal margin. Acalculous cholecystitis due to sepsis was suspected, but an abdominal computed tomography revealed emphysematous cholecystitis (Fig. 1). The patient underwent repeat back debridement and laparoscopic cholecystectomy. A gangrenous perforated gallbladder with gallstones was resected; cultures grew Klebsiella oxytoca. The patient was treated with 7 days of antibiotics for emphysematous cholecystitis followed by prolonged antibiotics for MSSA infection.
Figure 1
Computed tomography of the abdomen in axial (A) and coronal (B) views: A rim of gas surrounds the gallbladder (arrows) and there is an air-fluid level in the gallbladder (A).
