Abdominal infection reveals a rare disease

Excerpt

A 59-year-old man from Argentina had been well until he came to the Emergency Department (ED) of our hospital presenting with an acute acalculous cholecystitis. The patient was pyretic 38 °C, with mild right-upper abdominal pain (pain scale 5/10) and vomiting. The patient had type-II diabetes and Class-I obesity (BMI 32.7). At physical examination there were no signs of fluid retention, the lactate level was 1.9 mmol/L, and, at abdominal ultrasound (US), the gallbladder showed a thickened edematous wall with increased color-Doppler signals, but no stones or over-distension of the organ were observed. An irregular liver parenchyma with irregular liver profiles and a slightly increased spleen diameter were detected. The portal vein was patent. At blood test, the white blood cell (WBC) count, the C-reactive protein (CRP) and the transaminases were increased. The presence of viral or auto-immune hepatitis was serologically ruled out. …