논문 상세보기
pp.162-167
62세 여자가 약 7-10일간의 발열과 심와부 복통 및 오한으로 내원하여 단순한 급성 담석성 담낭염으로 진단받고 적극적인 시술과 약물치료를 받았으나, 임상경과가 호전되지 않고 비장경색의 합병증이 동반되어 추가 시행한 검사에서 삼일열 말라리아로 확진 받았다. 이후 절제된 담낭의 염증 소견은 말라리아 관련 급성 담낭염 소견을 시사하였다. 따라서 단순 급성 담석성 담낭염이라 하더라도 임상양상이 통상적인 회복소견을 보이지 않을 경우 다른 전신 질환에 합병된 담낭염의 가능성을 적극 고려해 보아야 한다.
Acute cholecystitis as a complication of malarial disease is a rare condition, especially with Plasmodium vivax infection. A 62 year-old-female was admitted via emergency room (ER) due to high fever (40.3°C) and epigastric pain. Initial abdominal ultrasound and computed tomography (CT) scan showed edematous gallbladder with stone, which suggested acute calculous cholecystitis. Emergency percutaneous transhepatic gallbladder drainage (PTGBD) was done with systemic antibiotic therapy. The clinical course, however, unusually worsened with hypotension and intensive care unit (ICU) management was done. Four days after admission multi-focal splenic infarction was developed and Plasmodium vivax infection was diagnosed afterward. The clinical symptoms and laboratory results, including fever and epigastric pain, improved dramatically after anti-malarial treatment and cholecystectomy was done. The resected gallbladder (GB) specimen shows vasculitis pattern with capillary red blood cell (RBC) engorgement, which suggests the cause of cholecystitis was due to Plasmodium vivax rather than GB stone.
