55 years old with rheumatic polyvalvulopathy who presents epigastric pain radiating to the back on a 48-hour belt, jaundice or choluria, acholia and fever (38.2).
Laboratory tests showed amylase 2.126 U/l, ALT 124 U/l, AST 169 U/l, GGT 3.548 U/l, AP 1.516 U/l, BrT 9.1 mg/dl and abdominal CT scan
She was admitted with a diagnosis of acute cholangitis and LAP. Empirical treatment with piperazilin-tazodone was initiated.
On the second day, both painful and erythematous subcutaneous nodules appeared on both sides, histologically compatible with PP.
Blood cultures were positive for R. planticola sensitive to the established treatment.
Magnetic resonance cholangiography (MRI) ruled out BDV and colitis.
The improvement of the stasis parameters and the absence of obstructive pathology, assuming spontaneous elimination of cholelithiasis, was decided not to perform ERCP.
On the thirteenth day she was discharged due to good evolution.
