We report herein the first case of acute acalculous cholecystitis caused by Lactococcus garvieae, which is known as a fish pathogen. A 69-year-old fisherman underwent laparoscopic cholecystectomy due to severe inflammation in the gallbladder. The isolate obtained from the gallbladder was identified as L. garvieae by 16S rRNA and manganese-dependent superoxide dismutase (sodA) gene sequence analysis.
CASE REPORTA 69-year-old man presented at Inje University Ilsan Paik Hospital (Goyang, Republic of Korea) with severe upper abdominal and postprandial pains for 2 days. His medical history included gastric ulcer perforation, fatty liver, and chronic alcoholism with tobacco use. The gastric ulcer perforation had been treated with exploratory laparotomy 19 years ago; however, the patient took no prescribed medications for fatty liver and alcoholism during that time. The patient was a fisherman by occupation, and during the middle period of his life worked at a fish culture farm located at the Han-tan and Nam-han rivers in the Republic of Korea. He occasionally ingested raw rainbow trout (Oncorhynchus mykiss) at that time and continued eating raw freshwater fish or shellfish frequently before this presentation. He had never traveled overseas.Physical examination on admission showed crouching with a blood pressure of 130/80 mm Hg, a heart rate of 73 beats/min, a respiratory rate of 20/min, and a body temperature of 36.3°C. The patient exhibited no evidence of murmur, jugular vein engorgement, or liver cirrhosis. His abdomen was mildly distended and soft, with normoactive bowel sounds, tenderness in the right upper quadrant, positive Murphy's sign, and no rebound tenderness. The results of routine tests were as follows: white cell count, 17,000 cells/l; polymorphoneutrophil count, 14,340 cells/l; hemoglobin, 15.1 g/dl; erythrocyte sedimentation rate (ESR), 15 mm/h; electrolytes (Na, K, and Cl), 138, 4.8, and 104 mEq, respectively; blood urea nitrogen (BUN) and creatinine, 15 and 1.1 mg/dl, respectively; aspartate transferase (AST) and alanine transaminase (ALT), 94 and 73 IU/liter, respectively; total bilirubin, 2.6 mg/dl; and urine analysis, clear.Abdominopelvic computed tomography (CT) findings were as follows: distension of the gallbladder, edematous wall thickening, and mild hyperemic change at the gallbladder bed. In addition, attenuation of parenchyma was lower in the liver than in the spleen. There were no remarkable findings in the pancreas, kidneys, spleen, or urinary bladder. No evidence of enlarged lymph nodes or ascites was found on CT scans. Therefore, the patient underwent laparoscopic cholecystectomy with closed drainage (Baro-vac), which showed a thickened, distended, hyperemic and edematous gallbladder. Obstructive stones were not observed in the gallbladder. There were no specific abnormalities in other organs, except that the liver angle was blunt. After the operation, the patient was treated with cefminox sodium (Meicelin) (2 g twice a day [b.i. Three specimens (one specimen each from the patient's bil...