Acalculous Perforated Hemorrhagic Emphysematous Cholecystitis Caused byClostridium perfringensin a Patient with Myeloma Taking Daratumumab

Abstract

Background: Acute calculous cholecystitis is a common disease entity familiar to every surgeon, however, variations such as acalculous cholecystitis, hemorrhagic cholecystitis, and emphysematous or gangrenous cholecystitis are rare. Diagnosis is more difficult and delays increase patient morbidity. Case Presentation: We present the case of a 75-year-old female Caucasian with multiple myeloma, undergoing treatment with daratumumab and dexamethasone, who was diagnosed with acute acalculous, emphysematous, perforated, and hemorrhagic cholecystitis. Active hemorrhage was demonstrated via contrast blush on computed tomography (CT) scan. She was treated expeditiously and recovered well. Cultures demonstrated a polymicrobial infection, including Clostridium perfringens. Conclusion: This is a complex case with unclear initial etiology, likely exacerbated by growth of Clostridium perfringens. It is possible that the patient's immunocompromised state contributed to infection that then lead to gallbladder emphysema, perforation, and hemorrhage. Thus, the clinician should be aware of the possibility of complicated cholecystitis in the immunocompromised patient, even in the absence of neutropenia, to avoid missing devastating complications of perforation or hemorrhage.