[Infectious mononucleosis : an atypical cause of acute alithiasic cholecystitis]. / La mononucléose infectieuse : une cause atypique de cholécystite aiguë alithiasique.

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.

Advances in the Study of Acute Acalculous Cholecystitis: A Comprehensive Review.

BACKGROUND: Acute acalculous cholecystitis (AAC) is characterized by acute necrotizing inflammation with no calculi and is diagnosed based on imaging, intraoperative, and pathological examinations. KEY MESSAGE: Although AAC has been studied clinically for a long time, it remains difficult to diagnose and treat. The pathogenesis of AAC is still not fully understood, and it is often regarded as a relatively independent clinical disease that is different from acute calculous cholecystitis (ACC). Pathological studies suggest that AAC is the manifestation of a critical systemic disease, while ACC is a local disease of the gallbladder. SUMMARY: Concerning the pathogenesis, diagnosis, and treatment of AAC, we reviewed the research progress of AAC, which will enhance the understanding of the early diagnosis and treatment of AAC.

[The 494th case: acute pancreatitis, acute acalculous cholecystitis and anaphylaxis].

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.

Hepatitis C Virus-Associated Acalculous Cholecystitis and Review of the Literature.

Acute acalculous cholecystitis (AAC) is an infrequently encountered clinical condition associated with high morbidity and mortality. Viral infection associated AAC is rare, but it is most commonly associated with Epstein-Barr virus, cytomegalovirus, dengue virus, hepatitis A, hepatitis B, human immunodeficiency virus, disseminated visceral varicella-zoster virus infection, Zika virus, and hepatitis C. We report on a patient who was first diagnosed with a chronic hepatic C infection and subsequently with acalculous cholecystitis.

Acute acalculous cholecystitis in patients with systemic lupus erythematosus: A unique form of disease flare.

Objective We aimed to investigate the clinical features of acute acalculous cholecystitis (AAC) in patients with systemic lupus erythematosus (SLE). Methods SLE patients with AAC hospitalized in the Peking Union Medical College Hospital (PUMCH) from January 2001 to September 2015 were retrospectively analyzed. Their medical records were systematically reviewed. The diagnosis of AAC was based on clinical manifestations and confirmed by radiologic findings including a distended gallbladder with thickened wall, pericholecystic fluid and absence of gallstones. Results Among the 8411 hospitalized SLE patients in PUMCH, 13 (0.15%) were identified to have SLE-AAC. Eleven (84.6%) of them were female, with a mean age of 30.1 ± 8.6 years. AAC was the initial manifestation of SLE in four (30.8%) cases. Eleven (84.6%) patients complained of fever and abdominal pain, four (30.8%) had positive Murphy's sign and six (46.2%) had elevated liver enzymes. The median SLE Disease Activity Index was 8.0 (range 0-20.0) at the time of AAC. Other affected organs in SLE-AAC included kidney (11, 84.6%) and hematologic system (11, 84.6%), followed by mucocutaneous (seven, 53.8%), musculoskeletal (seven, 53.8%) and neuropsychiatric (two, 15.4%) systems. All patients received treatment of glucocorticoids and immunosuppressants but none underwent surgical intervention. During a median follow-up of 28 months (range, 2-320 months), 12 cases (92.4%) responded to treatment with no relapse and one patient (7.6%) died of septic shock. Conclusion Our study suggests that AAC is a relatively uncommon and underestimated gastrointestinal involvement of SLE that is often associated with active disease. For patients with AAC in SLE, treatment with aggressive glucocorticoids could result in a good prognosis.

Acalculous cholecystitis in a female with cardiac device-related infective endocarditis.

Acute acalculous cholecystitis (AAC) is a necroinflammatory disease of the gallbladder with no gallstones present. ACC is known to be a serious, even potentially lethal complication observed mainly in patients with various severe underlying conditions including trauma, burn and sepsis. Infection of cardiac implantable electronic devices may lead to cardiac device-related infective endocarditis (CDRIE). The authors describe a case of a 55-year-old female with a history of advanced heart failure and implantation/reimplantation of biventricular pacemaker/defibrillator (CRT-D) for cardiac resynchronization therapy. She was admitted presently due to the symptoms of septicemia. Echocardiography revealed CDRIE with mobile vegetations on pacemaker leads; chest computed tomography showed pulmonary infarctions. Staphylococcus aureus was cultured from the blood. Antibiotics were applied in accordance with antimicrobial susceptibility and were continued after percutaneous leads extraction and pacemaker explantation. After 6 weeks of hospitalization, nonspecific abdominal symptoms developed, ultrasonography and computed tomography confirmed AAC diagnosis. Laparoscopic cholecystectomy was performed. To the best of the authors' knowledge, the case presented is the first report of ACC in a patient with CDRIE due to infection of pacemaker leads.

Atypical presentation of 'acalculous cholecystitis' with marked isolated hyperbilirubinaemia in patients treated for haematological malignancies.

Four patients diagnosed with haematological malignancies developed an isolated hyperbilirubinaemia following cytarabine- and anthracycline-based chemotherapy. The clinical picture was consistent with acalculous cholecystitis, but ultrasonography did not show the typical gallbladder wall thickening. All patients suffered from severe mucositis with neutropenic enterocolitis. We hypothesise that damage of the mucosa of the gallbladder induced by chemotherapy results in hyperpermeability of the mucosal barrier with bile leakage and isolated hyperbilirubinaemia.

Acute necrotising pancreatitis and acalculous cholecystitis: a rare presentation of leptospirosis.

Leptospirosis typically presents with fever and thrombocytopenia, with or without jaundice. Acute necrotising pancreatitis and acalculous cholecystitis are rare presentations of this spirochetal infection. Here is the case of necrotising pancreatitis and acalculous cholecystitis associated with leptospirosis in an elderly patient. Leptospirosis was diagnosed by serological tests and abdominal CT imaging. The patient was successfully treated medically with intravenous antibiotics (imipenem and ceftriaxone) and proper hydration.

[Acute acalculous cholecystitis: from common to rare causes]. / Akut acalculosus cholecystitis: a mindennapostól a nagyon ritkáig.

Diagnostic and therapeutic approaches of acute calculous cholecystitis are well defined. Cholecystectomy is among the most frequently performed surgical interventions. In contrast, acute acalculous cholecystitis is a secondary condition; its cause may be difficult to determine and indication for surgical intervention has not been clearly established. The authors summarize the primary causes of acute acalculous cholecystitis and discuss ultrasonographic features which may help the decision to perform cholecystectomy in patients with acalculous cholecystitis.

Can cannabinoids contribute to cholecystitis - a case of gangrenous acalculous cholecystitis.

SUMMARY: Cannabis legalisation continues to grow globally and its effects on the vascular system have been scrutinized.1 Cannabis has become recognised as a contributor to cardiovascular, cerebrovascular and peripheral vascular disease.2,3 This case report highlights the case of a young male patient presenting with atypical symptoms following cannabis use who developed gangrenous cholecystitis (GC) following vasospasm of his cystic artery. We believe that this is the first-ever case, shared with the anticipation of stimulating more research and prompting recognition of vascular events in this group of patients as our knowledge on the effects of cannabis continues to grow.

Acute acalculous cholecystitis due to hepatitis B virus reactivation: A case report and review of the literature.

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.

Acute acalculous cholecystitis in malaria: a review of seven cases from an adult cohort.

PURPOSE AND METHODS: Acute acalculous cholecystitis (AAC) is an uncommon condition related to serious clinical conditions, such as surgery, trauma, burn injuries and sepsis. The diagnosis of AAC remains challenging to make, since it generally occurs as a secondary event in acutely ill patients with another disease. Imaging evaluation is crucial, and well-known criteria are accepted for the diagnosis. To our knowledge, only case reports of AAC related to 12 malaria adult patients have been published. In this series, seven cases of AAC from a cohort of 42 adult patients with severe imported falciparum malaria [according to the World Health Organization (WHO) criteria] are presented. The aim is to report the cases and look for malaria conditions that may affect the incidence of this unusual malaria complication. RESULTS: Ultrasonography revealed gallbladder with wall thickening in all patients, plus other(s) major criteria. Each patient presented five to nine WHO severe malaria criteria: all had hyperparasitaemia and hyperbilirubinaemia. All patients developed renal failure, six pulmonary oedema/acute respiratory distress syndrome (ARDS) (five were mechanically ventilated) and five shock. Treatment was non-operative in five patients, cutaneous cholecystostomy was done in two and the outcome was favourable in all. CONCLUSIONS: Patients with AAC have significantly more commonly five or more criteria of severe malaria: renal insufficiency, pulmonary oedema/ARDS, parasitaemia higher than 30 %, nosocomial infection and a prolonged intensive care unit (ICU) stay. Increased awareness for this unusual and potentially severe complication of malaria is needed.

Acute acalculous cholecystitis: a rare complication of snake bite.

Snake bite is an environmental and occupational hazard in many tropical and subtropical countries. It demands a high level of knowledge and skill in managing the envenomation syndrome. Herein, we describe a rare case of acute acalculous cholecystitis (AAC) that developed in a 36-year-old man after an Indian cobra (Naja naja) bite in the absence of any other predisposing factors for AAC. The probable mechanisms for the occurrence of AAC have been highlighted. Recognizing the possibility of such a complication after envenomation will definitely aid in early diagnosis and, subsequently, a better outcome.

Percutaneous cholecystostomy as a definitive treatment for acute acalculous cholecystitis: clinical outcomes and risk factors for recurrent cholecystitis.

OBJECTIVE: To investigate the outcomes of percutaneous cholecystostomy (PC) as a definitive treatment for acute acalculous cholecystitis (AAC) and to identify the risk factors for cholecystitis recurrence after catheter removal. METHODS: Between January 2008 and December 2017, 124 patients who had undergone PC as definitive treatment for moderate or severe AAC. The initial clinical success, complications, and recurrent cholecystitis after PC removal were retrospectively assessed. Twenty-one relevant variables were analyzed to identify risk factors for recurrent cholecystitis. RESULTS: Clinical effectiveness was achieved in 107 patients (86.3%) at 3 days and in all patients (100%) at 5 days after PC placement. Six Grade 2 adverse events occurred, including catheter dislodgement (n = 3) and clogging (n = 3), which required catheter exchange. The PC catheter was removed in 123 patients (99.2%), with a median indwelling duration of 18 days (range 5-116 days). During the follow-up period (median, 1624 days; range, 40-4945 days), five patients experienced recurrent cholecystitis (4.1%). The cumulative recurrence rates were 3.3%, 4.1%, and 4.1% at 6 months, 1 year, and 5 years, respectively. Multivariate analysis revealed that an age-adjusted Charlson comorbidity index (aCCI)≥7 positively correlated with recurrence (OR, 1.97; 95% confidence interval, 1.07-3.64; p = 0.029). CONCLUSIONS: Definitive PC is a safe and effective treatment option for patients with AAC. The PC catheters can be safely removed in most patients. An aCCI≥7 was a risk factor for cholecystitis recurrence after catheter removal. ADVANCES IN KNOWLEDGE: 1. Percutaneous cholecystostomy (PC) is a safe and effective as a definitive treatment in patients with acute acalculous cholecystitis (AAC).2. PC can be safely removed after recover from AAC in the majority of patients (99.2%) with low rate of recurrence of cholecystitis (4.1%).3. Age-adjusted Charlson comorbidity index ≥7 was a risk factor for recurrence of cholecystitis after PC removal.

Acute acalculous cholecystitis-like phenotype in scavenger receptor A knock-out mice.

BACKGROUND: Sepsis is a major health problem in the United States that affects more than three-quarters of a million people every year. Previous studies have shown that scavenger receptor A (Sra), also known as macrophage scavenger receptor 1 (Msr1), is a modifier of interleukin 10 (IL-10) expression after injection of bacterial lipopolysaccharide (LPS). Therefore, we investigated the response to sepsis in Sra knock out mice. MATERIALS AND METHODS: C57BL/6J (B6) (n = 88) and Sra (-/-) mice (n = 88) were subjected to cecal ligation and puncture (CLP) using 18G or 16G needles, sham operation, or non-operated controls. At the end, mice were autopsied for the determination of abnormalities after the procedure. Cytokine gene expression was examined in lung and liver samples by quantitative RT-PCR (qRT-PCR), and circulating cholesterol levels were also measured. RESULTS: Sra (-/-) mice displayed an enlargement of the gallbladder after CLP that was not detected in sham or non-operated mice or in B6 mice (wild-type) after CLP. The enlarged gallbladder resembles a condition of acute acalculous cholecystitis observed in humans. Sra (-/-) mice presented high cholesterol levels in circulation as opposed to wild type B6 mice. Moreover, Sra (-/-) mice exhibited a reduction in IL-10 mRNA levels in lungs compared to wild-type B6 mice after CLP. CONCLUSIONS: The development of acute acalculous cholecystitis may be the combination of pre-existing conditions, such as hypercholesterolemia associated with a defect in Sra (Msr1) and a robust inflammation induced by sepsis.

Unusual presentation of multiple recurrent cardiac sarcomas as acute acalculous cholecystitis caused by rapid expansion into the right cardiac chamber: report of a case.

Sarcomas are rare malignant cardiac tumors and their prognosis is extremely poor, with a high recurrence rate despite extensive initial surgical resection. The development of therapeutic alternatives looks bleak for recurrent sarcomas, however, and complete surgical resection is crucial for any hope of survival even for the recurrent patients. We herein report the case of a 38-year-old male patient with multiple recurrent cardiac sarcomas causing acute acalculous cholecystitis 20 months after the resection of the primary tumor.

Safe and effective short-time percutaneous cholecystostomy: A retrospective observational study.

The introduction of percutaneous cholecystostomy (PCT) has shifted the paradigm in treatment of acute calculous and acalculous cholecystitis. PCT has high success and low complication rates, but there are still unresolved issues regarding the duration of the procedure. The aim of our study is to determine the characteristics and outcome of patients treated with short-term PCT drainage. Patients who were admitted to the Department of gastroenterology and the Department of Abdominal Surgery at the University Hospital Center Split under the diagnosis of acute cholecystitis and who were treated with the PCT, in a period between January 2015 and January 2020, were retrospectively included in the study. During that timeframe we identified 92 patients and have analyzed their characteristics and clinical outcomes. The statistical analysis included the Kaplan-Meier method for calculating survival curves for grades 2 and 3, the log-rank test for testing the difference between survival rates of grade 2 and 3 patients, and logistic regression to determine variables that affected the outcome of our patients. According to the Tokyo guidelines, most of the patients (74, 80.43%) met the criteria for grade 2 cholecystitis, and the minority had grade 1 (9, 9.78%) and grade 3 (9, 9.78%) cholecystitis. The average drainage duration was 10.1 ±â€…4.8 (3-28) days. We identified mild complications in 6 cases. Nine patients (10%) had lethal outcome. The mortality in the largest group of patients with grade 2 cholecystitis was 5.48% and as high as 71.43% in patients with grade 3 cholecystitis. The complication rate was 6.5%. One quarter of gallbladder aspirates showed a ciprofloxacin resistance. Short-time PCT lasting approximately 10 days can be used safely and effectively for the treatment of patients with acute cholecystitis.

Acute Acalculous Cholecystitis due to EBV Infection Presenting as Acute Abdomen.

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.