Detection of and in Bile from Two Patients with Chronic Xanthogranulomatous Cholecystitis: The Impact of Metagenomic Analysis.

Background: is thought to cause xanthogranulomatous cholecystitis (XGC). However, it is unclear whether other pathogens are associated with the cause and progression of XGC.

Case Presentation: Patient 1 was a 55-year-old man with a previous surgical history of right lung cancer. He presented with abdominal pain and was diagnosed with acute cholecystitis. He underwent endoscopic nasogallbladder drainage (ENGBD), antimicrobial therapy, and endoscopic sphincterotomy (EST). He underwent cholecystectomy on day 59. The patient was pathologically diagnosed with chronic phase XGC. was isolated from the bile sample during the operation. Patient 2 was a 58-year-old man with no previous medical history. He presented with abdominal pain and was diagnosed with acute cholecystitis. He underwent endoscopic retrograde biliary drainage (ERGBD) and antimicrobial therapy. His symptoms improved, but acute cholecystitis became exacerbated on day 53. The patient was treated with antimicrobial therapy. He underwent cholecystectomy on day 88. The patient was pathologically diagnosed with focal acute inflammatory phase XGC. was isolated from the bile during the operation. This study describes two patients with XGC, one infected with and the other with , in their gallbladders, which was identified by bacterial culture. Metagenomic analysis revealed that the genera and predominated and that other genera, including and , were also present, suggesting that these bacteria play a significant role in the pathological changes associated with XGC.

Conclusions: This is the first report of and infections in patients with XGC.