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KMID : 1144320200520040621
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감염과 화학요법
2020 Volume.52 No. 4 p.621 ~ p.625
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Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi
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Lee Keun-Hwa
Heo Sang-Taek
Jeong Seung-Uk
Kim Mi-Yeon
Jeong Woo-Seong
Hyun Chang-Lim
Kim Young-Kyu
Yoo Jeong-Rae
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Abstract
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Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.
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KEYWORD
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Tsutsugamushi Disease, Orientia tsutsugamushi, Cholangitis
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