Emphysematous cholecystitis in a young male without predisposing factors: case report.

Introduction and importance: Emphysematous cholecystitis (EC) is a rare, life-threatening form of acute cholecystitis, usually occurring in older patients with a history of diabetes mellitus and other comorbidities. Case presentation: We present a 36-year-old male patient with no predisposing factors who presented with right upper quadrant pain, fever, nausea, vomiting, and loss of appetite, which was clinically indistinguishable from acute non-EC. Multimodality imaging revealed gas within the lumen and wall of the gallbladder, confirming the diagnosis. Clinical discussion: This case is unusual due to the absence of advanced age and diabetes mellitus, highlighting that EC can occur outside the classic risk profile. The patient was treated with broad-spectrum antibiotics, and an open cholecystectomy was performed. Conclusion: Clinicians should maintain a high index of suspicion for EC, even in younger patients without predisposing factors, presenting with cholecystitis symptoms. Timely initiation of broad-spectrum antibiotics and prompt surgical management remain essential for reducing morbidity and mortality.