PMID- 35308700
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220322
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 2
DP  - 2022 Feb
TI  - Acalculous Cholecystitis: An Uncommon Presentation of Babesiosis.
PG  - e22165
LID - 10.7759/cureus.22165 [doi]
LID - e22165
AB  - Human babesiosis is commonly caused by Babesia microti, an infectious protozoan 
      with a preference for erythrocytes. We describe a case of babesiosis presenting 
      with acute acalculous cholecystitis. A 74-year-old man with a history of diabetes 
      mellitus presented with four days of fever, chills, dyspnea on exertion, and dark 
      brown urine. A physical exam was notable for scleral icterus. Laboratory findings 
      were significant for lactate dehydrogenase (LDH) of 518, total bilirubin of 7.4, 
      and direct bilirubin of 6.2. Imaging, including abdominal ultrasound, CT abdomen 
      and pelvis, magnetic resonance cholangiopancreatography (MRCP), and hepatobiliary 
      iminodiacetic acid (HIDA) scans, demonstrated acute acalculous cholecystitis. On 
      further history, the patient confirmed a recent hiking trip in Virginia. Further 
      evaluation, including peripheral smear and polymerase chain reaction (PCR), 
      was consistent with Babesia microti infection. Babesiosis is common in the 
      Northeastern and Midwestern United States, and symptoms can range from 
      asymptomatic infection to nonspecific malaise and fever to severe end-organ 
      dysfunction. Diagnosis is via peripheral smear or PCR, which can be confirmed via 
      serology. The combination of clindamycin and quinine or atovaquone and 
      azithromycin are the cornerstones of pharmacotherapy. Acute acalculous 
      cholecystitis is a very uncommon presentation of babesiosis. Babesia infection 
      must be considered in the differential in a patient with nonspecific symptoms 
      living in an endemic area.
CI  - Copyright (c) 2022, Khrais et al.
FAU - Khrais, Ayham
AU  - Khrais A
AD  - Internal Medicine, Rutgers University, New Jersey Medical School, Newark, USA.
FAU - Ramasamy, Dhanasekaran
AU  - Ramasamy D
AD  - Department of Gastroenterology, Cooperman Barnabas Medical Center, Center for 
      Digestive Diseases, Union, USA.
FAU - Kumar, Shiva
AU  - Kumar S
AD  - Department of Gastroenterology and Hepatology, Cleveland Clinic Abu Dhabi, 
      Digestive Diseases Institute, Abu Dhabi, ARE.
LA  - eng
PT  - Case Reports
DEP - 20220213
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8923042
OTO - NOTNLM
OT  - acute acalculous cholecystitis
OT  - babesiosis
OT  - gallbladder disorders
OT  - hemolysis
OT  - tick borne infections
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/03/22 06:00
MHDA- 2022/03/22 06:01
PMCR- 2022/02/13
CRDT- 2022/03/21 08:42
PHST- 2022/02/13 00:00 [accepted]
PHST- 2022/03/21 08:42 [entrez]
PHST- 2022/03/22 06:00 [pubmed]
PHST- 2022/03/22 06:01 [medline]
PHST- 2022/02/13 00:00 [pmc-release]
AID - 10.7759/cureus.22165 [doi]
PST - epublish
SO  - Cureus. 2022 Feb 13;14(2):e22165. doi: 10.7759/cureus.22165. eCollection 2022 
      Feb.