Publication: Acalculous cholecystitis in a young adult with scrub typhus: A case report and epidemiology of scrub typhus in the maldives
Issued Date
2021-12-01
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ISSN
24146366
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2-s2.0-85121288877
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Mahidol University
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SCOPUS
Bibliographic Citation
Tropical Medicine and Infectious Disease. Vol.6, No.4 (2021)
Suggested Citation
Hisham Ahmed Imad, Aishath Azna Ali, Mariyam Nahuza, Rajan Gurung, Abdulla Ubaid, Aishath Maeesha, Sariu Ali Didi, Rajib Kumar Dey, Abdullah Isneen Hilmy, Aishath Hareera, Ibrahim Afzal, Wasin Matsee, Wang Nguitragool, Emi E. Nakayama, Tatsuo Shioda Acalculous cholecystitis in a young adult with scrub typhus: A case report and epidemiology of scrub typhus in the maldives. Tropical Medicine and Infectious Disease. Vol.6, No.4 (2021). doi:10.3390/tropicalmed6040208 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77132
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Title
Acalculous cholecystitis in a young adult with scrub typhus: A case report and epidemiology of scrub typhus in the maldives
Abstract
Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey’s sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein–Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein–Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.