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JAMA Clinical Challenge
October 9, 2013

Abnormal Gallbladder Finding in a Septic Patient With Blood Loss

Author Affiliations
  • 1University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas
JAMA. 2013;310(14):1498-1499. doi:10.1001/jama.2013.278877

A 58-year-old man is admitted to the cardiac intensive care unit with fevers and night sweats. He has a history of a fall and a large hematoma on his right thigh and buttock. His white blood cell (WBC) count is elevated to 29 000 cells/μL without a left shift, and his serum hemoglobin level is 9.3 g/dL. A transthoracic echocardiogram, performed because of mildly elevated troponin levels without electrocardiographic changes, reveals valvular vegetations. Systemic antibiotics are administered for management of Streptococcus viridans endocarditis. On the fourth hospital day, his WBC count increases to 44 000 cells/μL and his hemoglobin level decreases to 6.6 g/dL. A chest radiograph is unrevealing. He is afebrile with normal blood pressure, tachycardic (119 beats/min), and has an unremarkable abdominal examination. An abdominal computed tomography (CT) scan obtained to evaluate for blood loss reveals an abnormal gallbladder finding (Figure).