Abstract

Rationale: Accurate, précised, and correct diagnosis is one of the most important cornerstones in clinical medicine. Pandemic COVID-19 virus infection represents the top widely spread disease in the current time. Acute cholecystitis is a common surgical disease. There is no more difficulty in its diagnosis. Typhoid fever is considered a serious multisystemic infection. Sometimes, the physician, surgeon, and internist deal with the patient based on his specialty view neglecting the other specialties. Undoubtedly, differential diagnosis is a base of medicine. Patient concerns: A 54-year-old, housewife, married, Egyptian female patient was initially diagnosed with acute calcular cholecystitis neglecting COVID-19 pneumonia with typhoid fever. Diagnosis: COVID pneumonia with typhoid fever versus calcular cholecystitis; escalation drama among internists and surgeons. Interventions: Abdomen ultrasound, electrocardiography, oxygenation, non-contrast chest CT, widal test, and echocardiography. Outcomes: Good response and better outcomes despite the presence of several remarkable risk factors were the results. Lessons: Combination of acute calcular cholecystitis, COVID-19 pneumonia, and typhoid fever is an extreme association. Accurate, précised, correct diagnosis with respecting the differential diagnosis surely will save the patient life. The escalating method for the cases among internists and surgeons is serious and may cause death for the patient. Co-operation is the base. The focusing of the specialist on his especially on the examination for the case should be changed. But he should deal with a case as a general case whatever the diagnosis.

Keywords: COVID-19 pneumonia, Typhoid fever, Cholecystits, Gallbladder disease, Internists, surgeons

Abbreviations:AAC: Acute Acalculous Cholecystitis; COVID-19: Coronavirus Disease 2019; DD: Differential Diagnosis; ECG: Electrocardiogram; ICU: Intensive Care Unit; O2: Oxygen; SGOT: Serum Glutamic-Oxaloacetic Transaminase; SGPT: Serum Glutamic-Pyruvic Transaminase; VR: Ventricular Rate; CTD: Connective Tissue Disease; AC: Acalculous Cholecystitis; POC: Physician Outpatient Clinic; BP: Blood Pressure; CBC: Complete Blood Count