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A 66-year-old female has a medical history of remote subarachnoid hemorrhage and dysphagia. She presented with acute onset of right upper quadrant abdominal pain. Ultrasound showed acute cholecystitis, and subsequent CT scan of the abdomen and pelvis showed gallbladder perforation. The patient’s hospital course was complicated with peritonitis, and bile culture grew vancomycin-resistant  Lactobacillus paracasei.  This case report will focus on an unusual case, in which  Lactobacillus  acts as the primary pathogen in peritonitis secondary to an cholecystitis-induced gallbladder perforation. There are four other case reports worldwide that illustrate  Lactobacillus  species as the primary pathogen in cholecystitis, only one of which was complicated with peritonitis.

Acute Cholecystitis Complicated with Gallbladder Perforation and Peritonitis Caused by Vancomycin-resistant Lactobacillus paracasei