Successful Non-surgical Treatment of an Acute Calculous Cholecystitis in a Myeloma Patient with Covid-19: Case Report

Abstract

COVID-19 has a wide spectrum of clinical phenotypes. While fever and cough are the most common symptoms, abdominal pain is rarely reported. We report the first case of COVID-19 pneumonia in an elderly patient with multiple myeloma (MM), complicated by acute calculous cholecystitis (ACC). A 73-year-old gentleman with underlying IgG kappa MM, presented with fever, cough and dyspnoea. His nasopharyngeal swab was positive for SARS-CoV-2. Piperacillin/tazobactam and oral hydroxychloroquine were started in addition to granulocyte colony-stimulating factor (GCSF) support due to neutropenia. Patient deteriorated on day 5, requiring high flow oxygen support. Dexamethasone, low molecular weight heparin prophylaxis and one dose of intravenous immunoglobulin were given. Despite negative swab on day 10, he developed ACC on day 17. With antibiotics and supportive care, patient showed full recovery without any surgical intervention. It remains elusive whether the gallbladder might be vulnerable to COVID-19, necessitating further validation via prospective studies. Keywords COVID-19 . Myeloma . Cholecystitis This article is part of the Topical Collection on Covid-19

Correlation of Inpatients Suffering from Acute Acalculous Cholecystitis during ICU Treatment with Acute Physiology and Chronic Health Evaluation II Score, Duration of Ventilator Use, and Time on Total Parenteral Nutrition

“…Acute acalculous cholecystitis (AAC) is a clinical emergency with lower morbidity, which tends to occur in critically ill patients with severe trauma, burns, shock, hypotension, or after major surgery, is featured with insidious onset, atypical clinical presentation, and rapid progression of the condition, and easily causes perforated gangrene and other complica-tions, leading to a high clinical mortality [1][2][3][4]. Most patients treated in ICU inpatient areas are critically ill with complex condition and often accompanied by multivisceral dysfunction, so they are at high risk for AAC; in addition, patients who undergo the therapeutic means such as sedation and mechanical ventilation often have disorders of consciousness, and thus, the condition of AAC is not easily perceived, resulting in a prolonged disease course and a high clinical mortality rate of 45-50% [5][6][7][8].…”