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P1P2Patient CHARACTERISTICS OF PATIENTSAge SexPast medical historyCause of acute cholecystitisLABORATORY DATAWhite blood cell count(cells/mm3)C-reactive protein (mg/dL) CEA(ng/ml) (< 5.0) / CA19-9(U/ml) (< 37.0)PREOPERATIVE CHARACTERISTICS Time from onset to operation (days)DrainageAntimicrobial agentsDischarge (Postoperative day) TG 18 SEVERITY CLASSIFICATION Mild/Moderate/Severe Blood cultureBacterial profile of bile culture OPERATIONOperation※ NA, not applicable; Af, Atrial fibrillation; ERGBD, Endoscopic retrograde gallbladder drainage; ENGBD, Endoscopic nasogallbladder drainage; EST, Endoscopic sphincterotomy; CMZ, cefmetazole; PIPC/TAZ, Piperacillin/Tazobactam; CTRX, Ceftriaxone; LVFX, Levofloxacin; MEPM, Meropenem Table 1　Clinical presentations and results of bacterial culture55MRight lung cancer AfCholesterol stones15500213.1 / 1159ENGBD ESTCMZ MEPM7ModerateNegativeAcinetobacter baumaniiLaparotomy cholecystectomypresent in bile.Two patients (P1 and P2) underwent cholecys-tectomy for suspected chronic cholecystitis in July 2018 at the Department of Hepato-biliary Pancre-atic Surgery, Juntendo University Hospital. Written informed consent was obtained from these patients before surgery. This study was conducted according to the principles of the Declaration of Helsinki, and approved by the Juntendo University ethics committee (JHS 18-060 Juntendo University Hospital Independent Ethics Committee). The clin-ical characteristics of these two patients are summarized in Table 1. Chronic cholecystitis in these patients was diagnosed as XGC by histo-pathological examination of the gallbladder samples. Patient 1 was a 55-year-old Japanese man with a previous surgical history of right lung cancer seven years earlier, and was admitted to an inten-sive care unit (ICU) with a mechanical ventilator. He presented with abdominal pain and was diag-nosed with acute cholecystitis. He underwent endo-58MNACholesterol stones9600261.9 / 1388ERGBDCMZ PIPC/TAZ CTRX LVFX 5ModerateNegativeStaphylococcus capitisLaparoscopic cholecystectomy283IntroductionXanthogranulomatous cholecystitis (XGC) is char-acterized histologically by the accumulation of numerous foamy macrophages in the gallbladder, resulting in thickening of the gallbladder wall1). Moreover, XGC is frequently diagnosed as gall-bladder carcinoma. Escherichia coli antigens have been detected immunohistologically in XGC lesions2), and E. coli was reported to be involved in the pathogenesis of XGC, with scavenger receptor class A and CXCL16-CXCR interactions3). These results suggested that E. coli infections of the gall-bladder play an important role in the onset and/or early stages of XGC. However, it is unclear whether other pathogens are associated with the cause and progression of XGC.This study describes the isolation of two other species of bacteria, Acinetobacter baumannii and Staphylococcus capitis, from the bile samples of two patients with XGC. Metagenomic analysis of the microbiota in bile samples confirmed that these pathogens, as well as other microorganisms, were Case report