PMC5410488_01
Abdominal CT on admission showing the thickness of the gallbladder wall (white arrowheads). There were no gallstones.
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Computed tomography showed significant thickening of the patient's gallbladder wall (Fig. 1) and the values of alkaline phosphatase and gamma-glutamyltranspeptidase were also elevated; however, she had no abdominal pain.
The Gram-negative spiral bacterium in the blood culture (black arrows).
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The next day, the patient's blood cultures were found to be positive (after 5 days of incubation) and microscopy showed gram-negative spiral bacteria (Fig. 2).
The clinical course of the present case. PSL: prednisolone, mPSL: methylprednisolone, MEPM: meropenem, ABPC: ampicillin, IPM/CS: imipenem/cilastatin, AZM: azithromycin, DRPM: doripenem, WBC: white blood cell (/muL), Hb: hemoglobin (g/dL), PLT: platelet (x103/muL), AST: aspartate aminotransferase (U/L), ALT: alanine aminotransferase (U/L), ALP: alkaline phosphatase (U/L), CRP: C-reactive protein (mg/dL), closed triangle: positive blood culture, open triangle: negative blood culture
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The clinical course is shown in Fig. 3.
Cellulitis complicated with secondary bacteremia was seen on both extremities and the patient's back.
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One month after the treatment, the H. cinaedi bacteremia relapsed with a high-grade fever and cellulitis (Fig. 4).