Abstract
We herein report a 76-year-old man with acquired hemophilia A (AHA) who developed
gallbladder rupture due to Ceftriaxone (CTRX)-associated pseudolithiasis. The patient
was admitted for an examination of systemic subcutaneous bleeding. A blood test showed
a prolonged activated partial thromboplastin time and sequentially revealed low factor
VIII activity (<1%) and a high factor VIII inhibitor level of 143 BU/mL. The patient
was thus diagnosed with AHA. After admission, he developed a high-grade fever and
was administered intravenous CTRX, considering the possibility of psoas abscess or
cellulitis. Although his high-grade fever was improved, computed tomography incidentally
showed a high-density lesion in the gallbladder, suggestive of CTRX-associated pseudolithiasis
without clinical symptoms. Despite cessation of CTRX, the pseudolithiasis never disappeared,
and the patient suddenly died after rapid progression of abdominal bloating. An autopsy
revealed that the gallbladder was severely swollen and had ruptured with hemorrhaging
because of hemorrhagic cholecystitis, caused by CTRX-associated pseudolithiasis with
AHA. Our case demonstrated that CTRX-associated pseudocholelithiasis can unexpectedly
induce gallbladder hemorrhaging and rupture in a patient with a bleeding diathesis,
including AHA. CTRX-associated pseudocholelithiasis can cause a fatal outcome in patients
with a bleeding disorder, even if CTRX is ceased as soon as pseudocholelithiasis is
detected.
Keywords
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Article info
Publication history
Published online: April 18, 2023
Accepted:
April 12,
2023
Received in revised form:
April 10,
2023
Received:
February 4,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
