Abstract
Atypical presentations can confuse the clinical picture, especially in patients with comorbidities. Particularly, rare pathogens, such as Lelliottia amnigena, can cause infections in immunocompromised patients or, sometimes, present as epidemic infections. We present a case of a female patient with a history of cryptogenic cirrhosis and poorly controlled diabetes, who developed acute calculous cholecystitis with positive bile cultures for L. amnigena, a rare, Gram-negative facultative anaerobic bacillus, usually associated with water sources and immunocompromised hosts. The patient also had positive titers for acute hepatitis A. This case is the first to our knowledge that reports L. amnigena-induced acute cholecystitis, along with concomitant acute hepatitis A positive serology. We aim to emphasize the importance of a broad differential diagnosis in such patients, early identification of rare pathogens, and the role of comprehensive clinical judgment in guiding treatment decisions.