title: Chronic cholecystitis with Cystoisospora belli in an immunocompetent patient.
abstract: A 47-year-old woman presented with a history of vague abdominal pain for several years, which worsened over the past 2 months, with pain more prominent in the right upper quadrant. She also had a history of peptic ulcer disease. The ultrasound scan of right upper quadrant revealed normal gallbladder and oesophagogastroduodenoscopy was unremarkable. A (99m)technetium labelled hepato iminodiacetic acid (HIDA) scan with cholecystokinin provocation demonstrated a decreased gallbladder ejection fraction (EF) of 32%. On this basis, the patient was diagnosed with biliary dyskinesia and underwent an elective laparoscopic cholecystectomy. Histopathological analysis revealed chronic cholecystitis with Cystoisospora belli identified in the gallbladder wall. Cystoisospora has been identified to cause an opportunistic acalculous cholecystitis among immunocompromised hosts, especially those with AIDS. This is the first case report of chronic cholecystitis due to C. belli in an immunocompetent patient.
authors.affiliation: Department of HPB Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Hideo
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of HPB Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Falk
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cruise
authors.affiliation: Department of HPB Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
mesh_terms: D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000276:immunology* / Q000382:microbiology* / Q000601:surgery; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007121:Immunocompetence; D021865:Isosporiasis / Q000175:diagnosis* / Q000276:immunology* / Q000601:surgery; D008875:Middle Aged