First case of acute cholecystitis due to Gemella morbillorum

Author(s):
Hugo Bonatti

Background:

Gemella morbillorum is a Gram positive coccobacillus rarely implicated in human disease. Cases of blood stream infection, joint infection and liver abscesses have been described.

Hypothesis:

Gemella morbillorum may be isolated from bile in the case of acute cholecystitis.

Methods:

We report on a 69 year old woman with acute cholecystitis caused by a novel rare pathogen.

Results:

The patient presented with acute right upper quadrant pain to the ER. Her WBC was elevated, her LFTs were normal and imaging showed acute calculous cholecystitis. She was given 2g of cefotetan, pain control was achieved and she was stable. No acute OR and no hospital bed were available and she agreed to be discharged on oral Augmentin with a plan for early elective laparoscopic cholecystectomy (LC) within three days. LC was done with two 5mm ports (LUQ, umbilicus) and a mini lap grasper (LUQ) in a modified dome down technique. The Gallbladder (GB) was acutely inflamed and distended; 80ml bile were evacuated using a puncture needle and a portion was sent for microbiology.. The patient developed a bile leak from an accessory bile duct from segment 5 which was successfully managed by ERCP and stenting and she had no other complications. The bile culture grew Gemella morbillorum; oral antibiotics were continued for a total of five days.

Conclusions:

We report the first case of acute cholecystitis involving Gemella morbillorum. The pathogen should be added to the ever expanding spectrum of pathogens involved in this common disorder. In patients with acute cholecystitis it may be advisable to send intraoperative specimens for microbiologic testing.