Acute Calculous Cholecystitis Associated with Leptospirosis: Which is the Emergency? A Case Report and Literature Review.

Introduction: Leptospirosis is a bacterium with a worldwide distribution and belongs to the group of zoonoses that can affect both humans and animals. Most cases of leptospirosis present as a mild, anicteric infection. However, a small percentage of cases develop Weil's disease, characterized by bleeding and elevated levels of bilirubin and liver enzymes. It can also cause inflammation of the gallbladder. Acute acalculous cholecystitis has been described as a manifestation of leptospirosis in a small percentage of cases; however, no association between leptospirosis and acute acalculous cholecystitis has been found in the literature.

Case Presentation: In this report, we describe the case of a 66-year-old patient who presented to the emergency department with a clinical picture dominated by fever, an altered general condition, abdominal pain in the right hypochondrium, nausea, and repeated vomiting. Acute calculous cholecystitis was diagnosed based on clinical, laboratory, and imaging findings. During preoperative preparation, the patient exhibited signs of liver and renal failure with severe coagulation disorders. Obstructive jaundice was excluded after performing an abdominal ultrasound and computed tomography scan. The suspicion of leptospirosis was then raised, and appropriate treatment for the infection was initiated. The acute cholecystitis symptoms went into remission, and the patient had a favorable outcome. Surgery was postponed until the infection was treated entirely, and a re-evaluation of the patient's condition was conducted six-week later.

Conclusions: The icterohemorrhagic form of leptospirosis, Weil's disease, can mimic acute cholecystitis, including the form with gallstones. Therefore, to ensure an accurate diagnosis, leptospirosis should be suspected if the patient has risk factors. However, the order of treatments is not strictly established and will depend on the clinical picture and the patient's prognosis.