Acute cholecystitis associated with pneumococcal bacteremia and purpura fulminans

T. Megas,1 A.M. Mega,² P. Vernikos, I. Pavleas,² S. Georgiou,² K. Rigas,; N. Archontoulis, D. Xanthis,² G. Thomopoulos

Authors T. Megas,1 A.M. Mega,² P. Vernikos, I. Pavleas,² S. Georgiou,² K. Rigas,, N. Archontoulis, D. Xanthis,² G. Thomopoulos.

Abstract

The case of a previously healthy 47-year-old woman who
was admitted to our hospital with symptoms of acute abdomen,
septic shock and cutaneus rash is presented. The U.S.
revealed cholelithiasis, cholecystitis and pericholecystitis
and the patient was immediately treated by surgical removal
of the gall bladder. In the blood culture a penicillin-susceptible
strain of Streptococcus pneumoniae (Pneumonococcus)
was isolated. After surgery the patient was transferred
to I.C.U. where she presented M.O.D.S. (Multiple
Organs Failure Syndrome) and D.I.C. (Disseminated Intravascular
Coagulation). She died two days later despite
pharmacologic therapy and mechanical support, of respiratory
and renal failure.
To our knowledge, this is a very rare case of acute cholecystitis
associated with pneumococcal bacteremia (we found
only five similar cases in the literature). Pneumococcal septic
shock is usually associated with immunosuppression or
asplenism (surgical or functional). In our patient functional
hyposplenism was diagnosed by identification of Howell-
Jolly bodies in the peripheral blood smear.
Key words: Pneumococcal bacteremia, S. pneumoniae bacteremia,
purpura fulminans, acute cholecystitis.