Fungal cholecystitis: Easily missed unless considered-A Case Report and Review of Literature

Abstract Background While gallstone disease remains the most common cause, a variety of other etiologies may also lead to acute cholecystitis. We present a rare case of acute cholecystitis in the backdrop of gall stone disease. Case Presentation : A 50-year-old diabetic female with recent history of diabetic foot ulcer, presented with right upper abdomen pain with associated fever. She was diagnosed with acute cholecystitis at outside hospital and received parenteral antibiotics. In view of persistent fever, she was referred to our hospital. She was evaluated with relevant investigations including a CECT abdomen which showed ill-defined heterogeneously enhancing gall bladder mass lesion with extension into liver parenchyma. Ultrasound guided FNA from the mass lesion showed fungal elements (hyphae and pseudo-hyphae). In view of high suspicion of underlying malignancy, PET CT scan was done which revealed FDG avidity in neck and body of gall bladder (SUV max 6.6) with extension into segment 4a, 4b and 5 of liver (SUV max 8.1). However, USG guided biopsy done from gall bladder fossa mass didn’t show any evidence of malignancy. Hence possibility of acute fungal cholecystitis with gall bladder perforation and liver abscess was considered. She was managed with liposomal amphotericin B for 2 weeks, following which her symptoms resolved completely. Repeat CECT abdomen and PET CT scan demonstrated near complete resolution of the mass lesion in liver bed with mild residual symmetrical wall thickening of gall bladder. Now she has been listed for cholecystectomy. Conclusions High clinical suspicion and histopathological evaluation are required to diagnose acute fungal cholecystitis and liver abscess.