We report a case of a 39 year-old woman with transfusion-induced malaria presenting as fever of unknown origin. She had been well until 2 months ago when lower abdominal pain developed. Pelvic ultrasonography revealed an ovarian mass and an operation was performed. Two weeks after the operation, she developed a fever. Peripheral blood smear revealed developmental stages of Plasmodium vivax. The patient had received two units of whole blood during the operation, which was later proven to have been donated by a asymptomatic soldier who contracted tertian malaria while serving near the DMZ, an endemic area of malaria in South Korea. Considering such a case, malaria should be included in the differential diagnosis of post-transfusion febrile episodes.
Abdominal Pain ; Adult ; Diagnosis, Differential ; Female ; Fever of Unknown Origin* ; Fever* ; Humans ; Korea ; Malaria* ; Military Personnel ; Plasmodium vivax ; Ultrasonography

BACKGROUND: Gallstone is one of the most common cause of acute abdominal pain and is increasingly managed by laparoscopic cholecystectomy. Silent gallstones are usually managed expectantly and are considered for surgery only if the characteristic biliary pain occurs. If predictors of stone-related complications such as acute cholecystitis, pancreatitis, and cholangitis can be identified, patients at high risk can be selectively referred for treatment regardless of symptoms development, while those at lower risk may be safely observed. The purpose of this study was to find out the predictors of stone-related complication or biliary pain in patients with gallbladder stones. METHODS: We collected clinical data retrospectively on patients who were diagnosed with gallstone at Asan Medical Center. Total gallstone number was classified into 1, 2~4, over 5. Diameter of the gallstones were subdivided into 20 mm. Statistical analysis was performed using SAS program (Ver 6.11). RESULTS: 918 patients (432 men and 486 women) were included in the analysis. The mean age was 54.3 years; that of men was 55 years and women was 53.8 years. Stone-related complications developed in 201 patients of acute cholecystitis, 78 patients of acute gallstone pancreatitis and 80 patients of acute cholangitis. Biliary pain was occurred in 568 patients. 658 patients were experienced cholecystectomy (158 patients open cholecystectomy and 500 patiens LLC). 377 patients were experiened ERCP, and 289 persons of that were experienced EST. Acute gallstone pancreatitis and acute cholangitis were significantly more frequent in older age and patients experiencing biliary pain. Their gallstone size was significantly smaller and the number was significantly more numerous in the univariate analysis. But, in the multiple logistic regression analysis, only age and the smallest stone size were independent risk factors. Patients who experiencing biliary pain were older and had significantly smaller and multiple gallstones in the univariate analysis. However in the multiple logistic regression analysis only age and stone number were independent variables. Acute cholecystitis was significantly more frequent in the old age group and patients with biliary pain. CONCLUSION: In the multiple logistic regression analysis, old age and small gallstones were predictors of acute gallstone pancreatitis and acute cholangitis. Old age and multiple gallstones were associated with biliary pain. Old age and biliary pain were predictors of acute cholecystitis, but the gallstone size and number were not associated in this study. We suggest that a well-designed prospective study is necessary in the future.
Abdominal Pain ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Chungcheongnam-do ; Female ; Gallbladder ; Gallstones* ; Humans ; Logistic Models ; Male ; Pancreatitis ; Retrospective Studies ; Risk Factors

There are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis.