A Case of Scrub Typhus Complicated by Acute Calculous Cholecystitis

Abstract

We report a case of acute calculous cholecystitis through scrub typhus. A 69-year-old woman presented with a history of general myalgia, fever, and right abdominal pain. She referred to our hospital for surgical treatment of clinically suspected acute cholecystitis. Physicians concluded the cause of cholecystitis as gall bladder (GB) stone and proper antibiotics treatment of scrub typhus was started later. The patient developed acute respiratory distress syndrome and multi organ failure through scrub typhus. Five days after admission, the patient was treated with proper antibiotics and discharged on the 13th day after starting doxycycline treatment without any sequelae. In areas endemic for tsutsugamushi disease, even though a patient with GB stone presents with symptoms of acute cholecystitis, careful history and physical examination are required to reveal the existence of eschars or skin eruptions.

Outcome of Intravenous Azithromycin Therapy in Patients with Complicated Scrub Typhus Compared with That of Doxycycline Therapy Using Propensity-Matched Analysis

“…No systematic studies have reported the treatment duration of complicated scrub typhus, with the exception of anecdotal reports (20)(21)(22). Although 10 to 14 days of antibiotics were used to treat complicated scrub typhus in several case reports, our study suggests that short-duration antibiotics are sufficient for treatment of complicated scrub typhus.…”

Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi

“…In previous reports of scrub typhus with acute cholecystitis, most patients presented with upper abdominal pain, changes in aminotransferase levels, and wall enhancement and distension of the GB on CT, leading to suspicions of acute cholecystitis and considerations of surgical treatment. As these patients did not present with a typical eschar [ 2 3 5 7 ], physicians did not include scrub typhus in the differential diagnosis of cholecystitis.…”

Acute Cholecystitis in Patients with Scrub Typhus

“…The symptoms of this disease are usually mild and self-limited; however, it is sometimes accompanied by severe complications such as pneumonia, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), meningoencephalitis, shock, gastrointestinal bleeding, and myocarditis ( 2 3 4 5 6 7 8 ). Scrub typhus complicated by acute cholecystitis has been rarely reported, and the clinical course of this complication is not well understood ( 9 10 11 12 13 14 ). Herein, we conducted a retrospective study to investigate the characteristics of acute cholecystitis in patients with scrub typhus.…”

“…A total of 1,733 reports were searched in PubMed (n=1,710) and website of The Korean Journal of Internal Medicine (n=23). A total of 7 subjects were identified as having scrub typhus complicated by acute cholecystitis ( 9 10 11 12 13 14 ).…”

“…Traditionally, old age (>60 yr), male gender, and the presence of cardiovascular disease and diabetes mellitus have been regarded as risk factors for acute calculous cholecystitis ( 18 ). In contrast severe illness causing ischemia of the gall bladder is a risk factor for acute acalculous cholecystitis ( 9 19 ). As for scrub typhus, old age (>60 yr), elevated creatinine (>1.4 mg/dL), low albumin (<3.0 g/dL), and leukocytosis (WBC >10,000/µL) have been shown to be associated with the development of various complications in scrub typhus ( 6 17 ).…”