Acalculous Cholecystitis Case Study

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INTRODUCTION: Acalculous cholecystitis(AAC) is an acute necroinflammatory disease of the gallbladder with a multifactorial pathogenesis. It accounts for approximately 10 percent of all cases of acute cholecystitis and is associated with high morbidity and mortality rates (1) Most cases of acute acalculous cholecystitis occur in the setting of prolonged fasting, immobility and hemodynamic instability (2), however autoimmune diseases like systemic lupus erythromatosus (SLE) has also been proposed as aetiology of AAC.Most of the cases of AAC associated with SLE has occurred in previously diagnosed cases of SLE (3) but here we are reporting a case of AAC which occured as a first manifestation of SLE CASE REPORT: A31 yrs old female hindu patient…show more content…
Guarding/rigidity present, positive Murphy’s sign ,X-ray abdominal standing was normal. Urgent Ultrasound Abdomen shows fatty liver, mild hepatosplenomegaly , lammelated gall bladder . Contrast computed tomography abdomen showed- increased gall bladder(GB) wall thickness with peri GB fluid collection and there was no evidence of GB calculi so diagnosis of acute acalculous cholecystitis was made. Patient was advised to manage conservatively by surgeon. Ryle's tube was inserted and was made continuous .She was kept nil by mouth . Antibiotics and IV fluids were continued. Injection Methyl prednisolone 1gm daily for 3 days started .Patient did not respond to steroids so Injection Cyclophosphamide 900 mg (750 mg/m2 with mesna was…show more content…
SLE is an autoimmune disease of unknown aetiology primary affecting joint,skin and kidneys(6). GI involvement is not so common in SLE,however vasculitis of mesentric vessel is assosciated with some of gi disorders caused by SLE and AAC is one of such disorder caused by vasculitis of mesentric vessels.(7) AAC has poorer prognosis as compared to calculous cholecystitis and it is generally managed by cholecystectomy(8). however in our case report patient was managed conservatively by immunosuppression with cyclophospamide showing good outcome. SUMMARY: We herein reported a rare case of SLE patient with AAC as an initial presentation who was treated successfully with high dose cyclophospamide pulse therapy and immunosuppressive agent.Awareness of this finding would be valuable in the early diagnosis and adequate management of AAC in patients with

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