RESUMEN
The Epstein-Barr virus (also known as EBV), responsible for infectious mononucleosis, is a virus that infects the majority of the world's population. Infection occurs in several forms, most often asymptomatic, or as a fever accompanied by pharyngitis and lymphadenopathies. A rare complication of infectious mononucleosis is acute acalculous cholecystitis, an inflammation of the gallbladder characterized by ischaemia and severe cholestasis. The diagnosis of this pathology is made by imaging, but determining the cause may be tricky. We present here the case of acute acalculous cholecystitis in a 21-year-old woman. This case highlights a rare complication of EBV infection that is probably under-diagnosed, and demonstrates the usefulness of interpreting liver tests and leukocyte count in association with imaging findings.
Le virus d'Epstein-Barr (aussi appelé EBV), responsable de la mononucléose infectieuse, est un virus qui infecte la majorité de la population mondiale. L'infection se présente sous plusieurs formes, soit, le plus souvent, asymptomatique, soit avec une fièvre accompagnée d'une pharyngite et de lymphadénopathies. Une des rares complications de la mononucléose infectieuse est la cholécystite aiguë alithiasique, une inflammation de la vésicule biliaire, caractérisée par une ischémie et une cholestase importante. Le diagnostic de cette pathologie est réalisé par imagerie et la détermination de la cause peut s'avérer compliquée. Nous présentons ici le cas clinique d'une cholécystite aiguë alithiasique chez une jeune femme de 21 ans. Ce cas nous permet de mettre en lumière une complication rare de l'infection par l'EBV, probablement sous-diagnostiquée, et démontre l'utilité d'interpréter les tests hépatiques ainsi que la formule leucocytaire en relation avec les résultats d'une imagerie.
Asunto(s)
Colecistitis Alitiásica , Mononucleosis Infecciosa , Humanos , Mononucleosis Infecciosa/complicaciones , Mononucleosis Infecciosa/diagnóstico , Femenino , Adulto Joven , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/virología , Colecistitis Alitiásica/etiología , Colecistitis Aguda/diagnóstico , Colecistitis Aguda/complicaciones , Colecistitis Aguda/etiologíaRESUMEN
BACKGROUND: Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites. CASE PRESENTATION: An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed. CONCLUSION: Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.
Asunto(s)
Colecistitis Alitiásica , Ascitis , Hepatitis A , Derrame Pleural , Humanos , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/virología , Hepatitis A/complicaciones , Hepatitis A/diagnóstico , Ascitis/etiología , Niño , Derrame Pleural/etiología , Masculino , Vitamina K/uso terapéutico , Dolor Abdominal/etiologíaRESUMEN
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
Asunto(s)
Colecistitis Alitiásica , COVID-19 , Colecistitis Aguda , Colecistitis , Adulto , Humanos , SARS-CoV-2/metabolismo , Colecistitis Alitiásica/diagnóstico , Peptidil-Dipeptidasa A/metabolismoRESUMEN
Primary Epstein-Barr virus (EBV) infection manifests with diverse clinical symptoms, occasionally resulting in severe complications. This scoping review investigates the rare occurrence of acute acalculous cholecystitis (AAC) in the context of primary EBV infection, with a focus on understanding its prevalence, clinical features, and underlying mechanisms. The study also explores EBV infection association with Gilbert syndrome, a condition that potentially exacerbates the clinical picture. Additionally, a case report of an 18-year-old female presenting with AAC and ascites secondary to EBV infection enhances the review. A comprehensive literature review was conducted, analyzing reported cases of AAC secondary to EBV infection. This involved examining patient demographics, clinical presentations, laboratory findings, and outcomes. The search yielded 44 cases, predominantly affecting young females. Common clinical features included fever, cervical lymphadenopathy, tonsillitis/pharyngitis, and splenomegaly. Laboratory findings highlighted significant hepatic involvement. The review also noted a potential link between AAC in EBV infection and Gilbert syndrome, particularly in cases with abnormal bilirubin levels. AAC is a rare but significant complication of primary EBV infection, primarily observed in young females, and may be associated with Gilbert syndrome. This comprehensive review underscores the need for heightened clinical awareness and timely diagnosis to manage this complication effectively.
Asunto(s)
Colecistitis Alitiásica , Infecciones por Virus de Epstein-Barr , Enfermedad de Gilbert , Femenino , Humanos , Adolescente , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico , Herpesvirus Humano 4 , Enfermedad de Gilbert/complicaciones , AscitisRESUMEN
We report a 52-year old man presenting with acute acalculous cholecystitis triggered by hepatitis B virus infection. The patient developed protective antibodies and cleared the infection. The relevant data is also discussed.
Asunto(s)
Colecistitis Alitiásica , Hepatitis B , Masculino , Humanos , Persona de Mediana Edad , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/etiología , Virus de la Hepatitis B , Hepatitis B/complicaciones , Hepatitis B/diagnósticoAsunto(s)
Colecistitis Alitiásica , Infecciones por Virus de Epstein-Barr , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/diagnóstico por imagen , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Herpesvirus Humano 4 , HumanosRESUMEN
Acalculous cholecystitis and pancreatitis are rare complications of scrub typhus in children. In febrile patients from an endemic area with multisystem involvement, scrub typhus should be a differential diagnosis. Scrub typhus patients who develop abdominal pain, acute cholecystitis or pancreatitis should be suspected.
Asunto(s)
Abdomen Agudo , Colecistitis Alitiásica , Pancreatitis , Tifus por Ácaros , Abdomen Agudo/complicaciones , Abdomen Agudo/etiología , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/etiología , Niño , Diagnóstico Diferencial , Humanos , Pancreatitis/diagnóstico , Tifus por Ácaros/complicaciones , Tifus por Ácaros/diagnóstico , Tifus por Ácaros/epidemiologíaRESUMEN
Acute acalculous cholecystitis is an acute inflammation of the gallbladder in the absence of stones, usually occurring in elderly and critically ill patients with underlying conditions. A 29-year-old man presented to the hospital complaining of abdominal pain in the right hypochondrium with permanent fever three days after Janssen COVID-19 vaccine inoculation. Abdominal ultrasound revealed a thickened gallbladder wall without evidence of gallstone consistent of an acute acalculous cholecystitis. Blood analyses revealed thrombocytopenia, eosinophilia and liver dysfunction. The Polymerase Chain Reaction (PCR) COVID-19 test was negative. As treatment, the patient benefited of pain management, antibiotic and fluid. In the evolution, there was a regression of clinical signs with persistence of liver dysfunction. The patient was discharged ten days after hospitalization. The Janssen COVID-19 vaccine is likely to induce acute acalculous cholecystitis as adverse event following vaccination.
Asunto(s)
Colecistitis Alitiásica , Vacunas contra la COVID-19 , COVID-19 , Colecistitis Aguda , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/etiología , Adulto , Anciano , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Colecistitis Aguda/diagnóstico , Colecistitis Aguda/etiología , Humanos , Masculino , VacunaciónRESUMEN
Background: The novel coronavirus disease 2019 (COVID-19) has rapidly spread worldwide since the outbreak in Wuhan, China, in 2019, becoming a major threat to public health. The most common symptoms are fever, dry cough, shortness of breath, but subjects with COVID-19 may also manifest gastrointestinal symptoms, and in a few cases an involvement of the gallbladder has been observed. Case report: Here we present a case of 50-year-old male with SARS-CoV-2 infection who had abdominal pain, vomiting and diarrhea without respiratory symptoms and was finally diagnosed as acute acalculous cholecystitis (AAC). Laparoscopic cholecystectomy was performed and found a gangrenous gallbladder; the real-time reverse transcription polymerase chain reaction SARS-CoV-2 nucleic acid assay of the bile was negative. We also made a review of the literature and try to understand the hypothetic role of SARS-CoV-2 in the pathogenesis of AAC. Conclusions: We highlighted that it is noteworthy to look at gastrointestinal symptoms in patients with SARS-CoV-2 infection and take into account AAC as a possible complication of COVID-19. Although more evidence is needed to better elucidate the role of the pathogenic mechanisms of the SARS-CoV-2 in AAC, it is conceivable that the hepatobiliary system could be a potential target of SARS-CoV-2.
Asunto(s)
Colecistitis Alitiásica , COVID-19 , Colecistectomía Laparoscópica , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/etiología , COVID-19/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Salud Pública , SARS-CoV-2RESUMEN
Epstein-Barr Virus (EBV) is a herpes virus with a high seropositivity rate among the adult population throughout the world. Primary EBV infection is usually asymptomatic among young children. As age increases, it begins to manifest as infectious mononucleosis. Gastrointestinal involvement is often mild and elevations in liver function tests are common in most cases. Here, we report a case of acute acalculous cholecystitis in a 15-year girl during the course of a primary EBV infection which is a very rare presentation in the pediatric population. Our patient recovered without any antibiotic or surgical treatment - parallel to the clinical improvement of the primary disease. Key Words: Epstein-barr virus (EBV) infection, Acute acalculous cholecystitis, Children, Antibiotics.
Asunto(s)
Abdomen Agudo , Colecistitis Alitiásica , Colecistitis Aguda , Infecciones por Virus de Epstein-Barr , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/etiología , Adulto , Niño , Preescolar , Colecistitis Aguda/diagnóstico , Colecistitis Aguda/cirugía , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Femenino , Herpesvirus Humano 4 , HumanosRESUMEN
ABSTRACT: A 14-year-old adolescent girl presented with severe abdominal pain, tenderness, and guarding in the right upper quadrant associated with nonbilious vomiting, scleral icterus, and fever. Laboratory tests were consistent with acute hepatitis A virus-related cholestatic hepatitis. A point-of-care ultrasound showed mild gallbladder wall thickening with increased color Doppler flow and pericholecystic fluid collection, in the absence of gallstones or biliary ducts dilatation, thus suggesting acute acalculous cholecystitis. Both the clinical symptoms and the point-of-care ultrasound findings completely resolved within 1 week after admission with conservative treatment.
Asunto(s)
Colecistitis Alitiásica , Hepatitis A , Ictericia , Dolor Abdominal/etiología , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/diagnóstico por imagen , Adolescente , Femenino , Hepatitis A/complicaciones , Hepatitis A/diagnóstico , Humanos , UltrasonografíaRESUMEN
A young male patient with abdominal pain and fever was diagnosed as acute hyper-triglyceridemicpancreatitis is clear. During the recovery of pancreatitis, the patient developed acute acalculous cholecystitis, as well as carbapenem-resistant Enterobacter infection and Cytomegaloviremia, and had anaphylaxis for several times after the use of antibiotics, which cannot be completely explained by drug allergy. This paper analyzes the possible causes of multiple diseases in the same patient in detail.
Asunto(s)
Colecistitis Alitiásica , Anafilaxia , Colecistitis Aguda , Pancreatitis , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/etiología , Enfermedad Aguda , Anafilaxia/complicaciones , Humanos , Masculino , Pancreatitis/complicacionesRESUMEN
Acute acalculous cholecystitis (AAC) is a rare disease, particularly in children. The clinical and laboratory presentation of AAC is variable. The diagnosis is based on radiological criteria. AAC is an atypical and rare complication of Epstein-Barr virus (EBV) infection, therefore we present a girl with AAC and cholestasis due to EBV primary infection. Conservative treatment and careful monitoring was followed by clinical, radiological and laboratory improvement, and finally complete recovery. Our aim was to highlight the importance of recognizing AAC as a differential diagnosis in children with abdominal pain and/or acute cholestasis.
Asunto(s)
Colecistitis Alitiásica , Colecistitis Aguda , Colestasis , Infecciones por Virus de Epstein-Barr , Niño , Femenino , Humanos , Preescolar , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Herpesvirus Humano 4 , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico , Colecistitis Aguda/complicaciones , Colestasis/etiología , Colestasis/complicacionesRESUMEN
RATIONALE: Acute retroviral syndrome is the symptomatic presentation of acute human immunodeficiency virus (HIV) infection, which often manifests as a self-limited infectious mononucleosis-like syndrome and occurs 2 to 6 weeks after exposure to HIV. Atypical manifestations including hepatitis, meningitis, or hemophagocytic lymphohistiocytosis have been reported. However, manifestations of acute acalculous cholecystitis during acute HIV infection are rarely reported. PATIENT CONCERNS: A 30-year-old man with nausea and loose stools, followed by fever and abdominal pain at the right upper quadrant for 10 days. DIAGNOSIS: Acute retroviral syndrome, complicated with acute acalculous cholecystitis. INTERVENTIONS: Percutaneous transhepatic gallbladder drainage was performed and treatment with co-formulated bictegravir/emtricitabine/tenofovir alafenamide was initiated upon HIV diagnosis. OUTCOMES: The patient's symptoms improved after the drainage. The levels of liver enzyme including aspartate transaminase alanine aminotransferase decreased to a level within normal limits 1 month after initiation of antiretroviral therapy. CONCLUSION: Acalculous cholecystitis in combination with acute hepatitis could be manifestations of acute HIV infection. For individuals at risk of acquiring HIV infection who present with manifestations of acute acalculous cholecystitis, HIV testing should be considered.
Asunto(s)
Colecistitis Alitiásica/etiología , Infecciones por VIH/complicaciones , Colecistitis Alitiásica/diagnóstico , Adulto , Antirretrovirales/uso terapéutico , Diagnóstico Diferencial , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , MasculinoRESUMEN
RATIONALE: Acute acalculous cholecystitis (AAC) is an extremely rare manifestation of systemic lupus erythematous (SLE). In previous reports, most of the patients were already diagnosed cases of SLE upon confirmation of AAC. PATIENT CONCERNS: A 24-year-old female who initially presented with fever and acute right upper quadrant abdominal pain. She had no medical history. DIAGNOSES: Abdominal ultrasonography and computed tomography (CT) showed gallbladder thickening with pericholecystic edema without gallstones or sludge, demonstrating acalculous cholecystitis. She revealed discoid rash on the both shin. Laboratory tests revealed pancytopenia. The titer of antinuclear antibody (ANA) was 1:1280. Anti-dsDNA antibody, anti-phospholipid antibody, anti-Sm antibody test, and proteinuria in 24âhours were positive. Both C3 and C4 were low. Echocardiography and chest CT showed pericardial effusion and pleural effusion. Using the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria, the score was 31. We thought AAC of this case that was one of the initial manifestations of SLE. INTERVENTIONS: The patient was treated with high-dose prednisolone (1âmg/kg) and hydroxychloroquine 400âmg. OUTCOMES: After 4âdays of administration of high-dose corticosteroid therapy, symptoms rapidly improved. After 35âdays of the treatment, her symptoms and disease activity of SLE were markedly improved. LESSONS: Although AAC being the initial manifestation of SLE is very rare, prompt diagnosis and management with corticosteroids precluded surgical intervention. Physicians need to be cognizant of AAC as a disease flare and as a rare initial manifestation of SLE.
Asunto(s)
Colecistitis Alitiásica/etiología , Vesícula Biliar/patología , Lupus Eritematoso Sistémico/complicaciones , Colecistitis Alitiásica/diagnóstico , Enfermedad Aguda , Adulto , Anciano , Anticuerpos Antinucleares/sangre , Antirreumáticos/administración & dosificación , Antirreumáticos/uso terapéutico , Niño , Quimioterapia Combinada , Ecocardiografía/métodos , Femenino , Vesícula Biliar/diagnóstico por imagen , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/administración & dosificación , Hidroxicloroquina/uso terapéutico , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Derrame Pericárdico/diagnóstico , Derrame Pleural/diagnóstico , Prednisolona/administración & dosificación , Prednisolona/uso terapéutico , Proteinuria/diagnóstico , Proteinuria/etiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía/métodos , Adulto JovenRESUMEN
Acute acalculous cholecystitis is a gallbladder wall inflammation without gallstones. It was not reported before as a manifestation of systemic juvenile idiopathic arthritis. Here, we describe a 13-month-old boy presented with prolonged intermittent fever, skin rash, arthritis, serositis, and hepatomegaly. After workup, he was diagnosed with systemic juvenile idiopathic arthritis and acute acalculous cholecystitis based on an ultrasound abdomen showing thick gallbladder wall with free fluid. After treatment with three days of intravenous pulse methylprednisolone, he improved dramatically, and repeated ultrasounds showed normal gallbladder. This suggests that Acute acalculous cholecystitis can be a part of systemic juvenile idiopathic arthritis and hypothesised that surgical intervention can be avoided with the use of corticosteroids.