| A case of acute acalculous cholecystitis in Tsutsugamushi disease with endobronchial tuberculosis co-infection |
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Yu Jin Kang, Su Min Kim, Mi Hyi Park, Sul Park, Jae Jin Jeong, Goeng Bae Kim, Youn Sun Lee |
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| 쯔쯔가무시병에 의한 급성 무결석 담낭염과 동시 감염된 기관지 결핵 1예 |
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강유진·김수민·박미희·박 설·정재진·김굉배·이연선, Su Min Kim, Mi Hyi Park, Sul Park, Jae Jin Jeong, Goeng Bae Kim, Youn Sun Lee |
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| Abstract |
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Acute acalculous cholecystitis, induced by Tsutsugamushi disease, is rare. A 69-year-old woman was admitted with eschar, fever,
and right upper quadrant (RUQ) abdominal pain. The patient’s blood chemistry showed a high titer of anti-Rickettsia
(R)-Tsutsugamushi antibodies. Abdominal ultrasonography showed gall bladder distension with wall thickening and ultrasonographic
Murphy’s sign. Thus, we first diagnosed acalculous cholecystitis and pneumonitis in scrub typhus, which was treated with
macrolide antibiotics, but the patient’s right lung collapsed. By bronchoscopic examination, endobronchial tuberculosis was
determined. The patient had rheumatoid arthritis, which was treated by leflunomide and steroids. We suggest that leflunomide may
have aggravated the scrub typhus infection and induced tuberculosis co-infection. The patient was successfully treated with appropriate
antibiotic therapy following an early diagnosis by physical examination, radiologic, and bronchoscopic studies. (Korean J
Med 77:S1193-S1197, 2009) |
| Key Words:
Tsutsugamushi disease; Acalculous cholecystitis; Endobronchial tuberculosis; Leflunomide |
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