An Accidental Diagnosis on Chest X-Ray in a Renal Transplant Recipient

A 29 year-old man with history of living donor renal transplant in 2004 (donor mother), new onset diabetes post-transplant, chronic allograft nephropathy and type 1 renal tubular acidosis was admitted with bilateral loin pain and backache. On the basis of the Chest X-ray (CXR) Emphysematous Cholecystitis (E.C) was suspected and an Abdominal CT was done. He was started on antibiotics and underwent laparoscopic cholecystectomy. Postoperatively he developed biliary leak requiring ERCP and laparoscopic peritoneal lavage. He was discharged 11 days later on oral antibiotics. We report a case of E.C a relatively rare and virulent variant of A.C in a post renal transplant patient who presented with insidious symptoms and never developed the classical symptoms of Acute Cholecystitis (A.C). There was no right upper quadrant pain, nausea or vomiting. He was diagnosed accidentally on a CXR and early initiation of antibiotics and surgical intervention prevented morbidity and mortality. His imaging and histopathology showed all the classical features of E.C.