Acute cholecystitis as an unusual presentation of scrub typhus: a report of two cases and review of the literature.
We present 2 cases
of scrub typhus with cholecystitis. The first patient is a 62 year old female who
presented to the hospital with fever and body aches for 1 week and right upper
quadrant abdominal pain for 3 days. She gave a history of an insect bite 2 weeks
previously. She was diagnosed as having acute cholecystitis and underwent cholecystectomy.
She continued with fever post-operatively and physical examination
revealed an eschar. She had an immunofluorescence assay (IFA) performed that
revealed a high IgM titer for Orientia tsutsugamushi. She was diagnosed as having
scrub typhus, treated with doxycycline and she recovered completely. The second
patient also presented to the hospital with a 1 week history of fever and upper
quadrant abdominal pain. She was diagnosed with having cholecystitis. Her
symptoms did not improve with intravenous antibiotics and further investigation
revealed elevated titers for O. tsutsugamushi and Leptospira interrogans. She was
diagnosed as having a co-infection of scrub typhus and leptospirosis and treated
with doxycycline. She recovered completely. Patients from scrub typhus endemic
regions who present with acute cholecystitis but do not respond to traditional
treatment should be tested for scrub typhus and leptospirosis and should have a
careful admission physical examination looking for eschar formation, since scrub
typhus may present with acute cholecystitis.
PMID: 29644830 [PubMed - in process]
Source: Southeast Asian Journal of Tropical Medicine and Public Health - Category: Tropical Medicine Tags: Southeast Asian J Trop Med Public Health Source Type: research
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