Cholecystitis enfisematous suspected SARS-CoV-2 infection

The patient is an 82-year-old woman with cirrhosis of the liver due to hepatitis C, portal hypertension, heart failure and chronic kidney disease, who reported functional impairment, vomiting and pain in the right upper quadrant over the previous three days. Lab work-up showed neutrophilia, metabolic acidosis and CRP 13.09.

Contrast-enhanced abdominal CT showed bilateral, peripheral and basal pulmonary ground glass opacities suggestive of SARS-CoV-2, although the PCR was negative. The gallbladder was distended, with air-filled walls and biliary sludge, and perihepatic and pelvic fluid were observed (Fig. 1).

Fig. 1

Surgery was ruled out (Fig. 2) due to high risk of morbidity and mortality. Conservative treatment with antibiotics was agreed upon, and the patient died 24 h after admission.

Fig. 2

Diagnosis: emphysematous cholecystitis