Cholecystitis – Mode of First Presentation of Sickle Cell Anemia in an Adult Nigerian: A Case Report

Background: This article aimed to sensitize the healthcare providers to the possibility of late and atypical presentation of sickle cell anemia (SCA).

Case Presentation: A 24 year old female university undergraduate presented to the Medical out-patient Department of our hospital with complaint of abdominal pain, vomiting, and yellowness of the eyes, all of 2 days prior to presentation. Abdominal pain was located at the right hypochondrial region, colicky in nature, not relieved nor aggravated by any known factor and does not radiate to any part of the body. There was associated vomiting, fever, weakness, and loss of appetite. Patient has been on apparent good health. No previous history of hospital admission(s), surgery nor blood transfusion. Physical examination showed an acutely ill-looking young girl in painful distress, febrile to touch, moderately pale, icteric, no pedal edema and no peripheral lymphadenopathy. Abdominal examination showed right hypochondrial tenderness, hepatomegaly and splenomegaly. A provisional diagnosis of hepatitis was made. However, in the course of investigations, there was no evidence of hepatitis rather cholelithiasis was reported by abdominal ultrasound scan. In the course of investigating for the cause of cholelithiasis, patient was diagnosed to have sickle cell anemia.. She subsequently had cholecystectomy done and is currently being followed up.

Conclusion: Patients with SCA usually present in infancy or early childhood with dactylitis, bone pain and/or symptomatic anemia which usually require frequent hospital admissions and blood transfusion especially in the absence of adequate care and follow up. This case is therefore to alert the health care providers to have high index of suspicion for late presentation in an atypical manner.