A Case of Gangrenous Cholecystitis during Tocilizumab Therapy Successfully Treated with Early Surgical Intervention

Abstract

A 64-year-old man with TAFRO syndrome receiving tocilizumab (TCZ) for 17 months presented with right upper quadrant pain one day after discharge for choledocholithiasis. Despite being afebrile and having normal inflammatory markers (WBC and CRP), computed tomography (CT) showed gallbladder enlargement and wall thickening, consistent with acute cholecystitis. Emergency laparoscopic cholecystectomy was performed the same day. Intraoperative findings revealed gangrenous changes in the gallbladder, and histopathology confirmed gangrenous cholecystitis. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. This case illustrates that the anti-inflammatory effects of TCZ can mask the clinical and laboratory signs of severe infection, such as gangrenous cholecystitis. Careful evaluation and prompt surgical intervention are crucial among these patients.