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A 67-year-old man with poorly controlled, insulin-dependent diabetes presents with 3 days of fever, nausea, and abdominal pain. He reports the pain as constant and localized in the right upper quadrant. Vital signs are: temperature 38.9° C (102 °F), heart rate 110 beats/minute, blood pressure 110/70 mm Hg, respiratory rate 22/minute, and oxygen saturation 95% on room air. His abdomen is soft, but tender to palpation in the right upper quadrant, with a positive Murphy sign.

Laboratory results are notable for a white blood cell count of 22,000/µL and a blood glucose level of 320 mg/dL.

Computed tomography the abdomen is obtained, which is notable for distension of the gallbladder, indicating gallbladder wall thickening, intramural air, and stranding (see Figure).

Which of the following statements is true regarding this patient’s diagnosis?

This case, like the majority of cases, is due to gallstones.
It carries a high risk of gallbladder perforation.
The Murphy sign is always present.
A history of diabetes is noncontributory.