Concurrent diabetic ketoacidosis, acute pancreatitis, and subsequent ruptured acalculous cholecystitis in a patient receiving semaglutide: A case report

A 70-year-old male with type 2 diabetes presented to the emergency department with severe abdominal pain and dyspnea after 24 weeks of treatment with weekly subcutaneous semaglutide (1 mg). He was diagnosed with acute pancreatitis and diabetic ketoacidosis (DKA) and admitted to the intensive care unit. Following 5 days of stabilization and symptom relief, he was transferred to a general ward. However, the patient subsequently developed a high-grade fever persisting for 3 days, accompanied by severe leukocytosis, despite normalized serum lipase levels. A repeat abdominal computed tomography scan revealed acute acalculous cholecystitis complicated by gallbladder rupture. The patient underwent emergency percutaneous transhepatic gallbladder drainage and antibiotic therapy, leading to gradual recovery. This clinical course illustrates a rare cascade of severe complications in a patient receiving a glucagon-like peptide-1 (GLP-1) receptor agonist. Specifically, when new-onset systemic symptoms emerge following the initial stabilization of a critical illness, clinicians should maintain vigilance for repeating imaging studies. This rare case highlights the need for further investigation into whether the pharmacological effects of GLP-1 receptor agonists, such as biliary stasis, might act as a predisposing factor for complex biliary complications in the setting of severe physiological stress.