Female, 67 years old, was admitted to the hospital on 30 January 2020 due to "fever for 1 week". The patient developed fever without obvious trigger 1 week ago, the highest body temperature was unknown, accompanied by obvious chest tightness, shortness of breath, no cough, expectoration, no fear of cold and chills. Previous history of recurrent upper abdominal discomfort. Because a family member returned home from Hubei, this patient was isolated in a local hotel. The throat swab test results of Pujiang County CDC showed that the nucleic acid test of novel coronavirus (2019-nCoV) was positive and transferred to the isolation ward of our hospital for treatment. The results of chest CT examination on January 31st showed inflammation in the lower lobes of both lungs. Blood routine: white blood cell count, lymphocyte count and C-reactive protein normal (Table 1), procalcitonin was slightly elevated. Admission diagnosis: SARS-CoV-2 pneumonia (common type). On the second day of admission, the blood routine revealed a decrease in lymphocyte count and a normal white blood cell count. After admission, he was given antiviral, oxygen inhalation, glucocorticoid and other related treatments, and his body temperature returned to normal (Figure 1), the symptoms of chest tightness and shortness of breath improved, but the fecal 2019-nCoV nucleic acid test on February 9 was still positive. On February 10th, chest CT examination showed that the inflammation of the upper lobe of left lung and the lower lobes of both lungs did not improve compared with before. Continue to treat SARS-CoV-2 pneumonia in isolation wards. On the night of February 11th, I had sudden chills and fever, with the highest body temperature of 37.8℃, a slight cough, and dull pain in the upper abdomen when coughing. On the night of February 12th, chills and fever appeared again, with the highest body temperature of 38.4℃, cough and abdominal distension. The 2019-nCoV nucleic acid test of throat swabs was negative twice on February 12 and 13. Chest CT examination on February 13: Lung inflammation progressed compared with previous. Abdominal CT findings revealed enlarged gallbladder (Figure 2）。 Blood routine: Neutrophil percentage 80.1%, lymphocyte count 1.00×109/L, C-reactive protein 59.29 mg/L. Organized Jinhua expert group for consultation, considering body temperature rebound, cough, low lymphocyte count, but 2019-nCoV RNA test was negative twice; Physical examination showed right abdominal tenderness, no rebound pain, negative Murphy sign, and abdominal CT showed gallbladder enlargement; The consultation opinion is that the possibility of acute cholecystitis is high. While treating novel coronavirus pneumonia, cefoperazone sodium and sulbactam sodium should be combined with anti-infection, light diet, choleretic and other treatments. After 48 h of anti-infective treatment, the patient still had fever and chills, aggravated pain, accompanied by nausea and vomiting, heart rate 90-95 beats/min, obvious tenderness in the right upper abdomen, and positive Murphy sign. Routine blood test results on February 15, 2020: white blood cell count normal, neutrophil ratio 86.6%, lymphocyte count 0.64×109/L, sodium 128.6 mmol/L, chloride 94.7 mmol/L, CRP 90.38 mg/L, IL-6 134.623 ng/L.
