Beyond conventions, medication-induced organ damage: exploring a case of gangrenous cholecystitis in a healthy young adult male on fluoxetine and amphetamines


  • Christina C. Sneed Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
  • Martine A. Louis Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
  • Denis Gratsinsky Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
  • Kelly Cervellione Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA



Acute cholecystitis, GC, Fluoxetine, Amphetamines


Acute cholecystitis occurs in 1 to 2% of patients with gallstones, with 2 to 20% progressing to gangrenous cholecystitis (GC). Within the realm of acute cholecystitis, GC presents itself as a formidable challenge, with a higher mortality rate (15 to 50%) compared to uncomplicated cholecystitis (3%) and elusive preoperative diagnosis. Traditionally observed among the elderly population burdened by comorbidities, GC's emergence in younger patients with no apparent risk factors sets the stage for intriguing exploration. Our case report involves a healthy young adult male on fluoxetine and amphetamines, introducing the potential of medication-induced ischemia leading to the development of GC.


Lee SO, Yim SK. Management of Acute Cholecystitis. Kor J Gastroenterol. 2018;71:264-8.

Önder A, Kapan M, Ülger BV. Gangrenous cholecystitis: mortality and risk factors. Int Surg. 2015;100:254-60.

Padda MS, Sanchez M, Akhtar AJ. Drug-induced cholestasis. Hepatology. 2011;53:1377-87.

Gomi H, Solomkin JS, Schlossberg D. Tokyo Guidelines. 2018;25:3-16.

Sharbaf Shoar N, Marwaha R, Molla M. Dextroamphetamine-Amphetamine. StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.

Ciupilan E, Gapp M, Stelzl R. Amphetamine-induced small bowel ischemia-A case report. Radiol Case Rep. 2020;6:2183-87.

Zou X, Huang H, Yang L. Methamphetamine consumption and life-threatening abdominal complications: A case report. Medicine (Baltimore). 2018;97:0647.

Simon LV, Keenaghan M. Serotonin Syndrome. StatPearls, Treasure Island (FL): StatPearls Publishing. 2023.

Khouri C, Gailland T, Lepelley M. Fluoxetine and Raynaud's phenomenon: friend or foe? Br J Clin Pharmacol. 2017;83:2307-9.

Sills TL, Greenshaw AJ, Baker GB. Acute fluoxetine treatment potentiates amphetamine hyperactivity and amphetamine-induced nucleus accumbens dopamine release: possible pharmacokinetic interaction. Psychopharmacology (Berl). 1999;141:421-7.

Mossaab G, Ben Khlifa M, Karim N. Acute acalculous cholecystitis in hospitalized patients in intensive care unit: study of 5 cases. Heliyon. 2022;11:11524.

Fosburg R. Gallstones in young adults: An analysis of 178 patients under thirty years of age. Am J Surg. 1963;106(1):82-8.

Siada S, Jeffcoach D, Dirks RC, Wolfe MM, Kwok AM, Sue LP et al. A predictive grading scale for acute cholecystitis. 2019,4(1):000324.

Augusto Gomes C, Cleber S, Salomone DS, Massimo S, Poliana GSS, Agnes SO et al. Gangrenous cholecystitis in male patients: A study of prevalence and predictive risk factors. Ann Hepatobiliary Pancreatic Surg. 2019;23(1):34-40.

Nidimusili AJ, Chadi MA, Naseem E, Abdul HA, Khaldoon S. Leukocytosis of Unknown Origin: Gangrenous Cholecystitis. 2013;2013:418014.

Bakri K, Abu-Shaban K, Doddi S, Xiaochen L, Garett AB. Distinguishing Between Gangrenous Cholecystitis and Ascending Cholangitis: A Case Study. Cureus. 2022;23(8):28322.






Case Reports