Acute Acalculous Cholecystitis due to primary acute Epstein-Barr virus infection treated with laparoscopic cholecystectomy; a case report

Background Acute acalculous cholecystitis (AAC), an inflammatory process of the gallbladder (GB) in the absence of gallstones, typically occurs in seriously ill patients. AAC can complicate primary Epstein‐Barr virus (EBV) infection, but it is an atypical clinical presentation. Aim The aim of our study was to analyse AAC occurrence in children with primary symptomatic EBV infection who had been admitted to the hospital. Methods We retrospectively evaluated the medical documentation of 181 children with EBV infection who were diagnosed based on the presence of viral capsid antigen IgM antibodies. All EBV‐positive patients underwent transabdominal ultrasonography of the liver in the supine and right anterior oblique positions. Fifteen children who presented with AAC symptoms, including abdominal pain and a positive Murphy's sign, were analysed as a subsample and re‐evaluated after 2‐3 months. Results The incidence of AAC in children hospitalised with infectious mononucleosis (IM) was estimated at 8.3%. Analysis of the laboratory results confirmed that the C‐reactive protein (CRP) concentration was the only parameter which was higher in children who presented with AAC symptoms. The mean number of leucocytes and monocytes and liver enzyme activities were not significantly higher. The radiological findings of AAC were evident: increased GB wall thickness, non‐shadowing echogenic sludge and pericholecystic fluid collection. Conclusion AAC during primary EBV infection appears to be a more common pathology than previously suspected. Its relatively mild nature and the lack of laboratory abnormalities mean that ultrasonographic examination is required for diagnosis. This might explain why the prevalence in children is underestimated.

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“…Our analysis did not confirm a predominance of females in the group with cholecystitis as highlighted in previous articles …”

Section: Discussioncontrasting

confidence: 90%

Epstein‐Barr virus infection with acute acalculous cholecystitis in previously healthy children

Mazur‐Melewska¹,

Derwich²,

Mania³

et al. 2019

Int J Clin Pract

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“…Another patient who also received corticosteroids improved rapidly [29]. In the second patient who underwent surgery, operation improved her symptoms [33].…”

Section: Resultsmentioning

confidence: 94%

“…Histology findings were not reported [10]. e second patient who underwent surgery was a 25-years-old immunocompromised female [33]. e postoperative course was uncomplicated.…”

Section: Resultsmentioning

confidence: 99%

“…In cases of acalculous cholecystitis due to EBV infection, the pathophysiology still remains obscure. Direct invasion of the gallbladder, as EBV can infect epithelial cells, has been proposed, but this theory has not been clearly proved in the few cases that surgery was performed [10,23,33,42]. Fretzayas et al based on scintigraphic data proposed that cholecystitis due to EBV infection may not represent a true cholecystitis, but rather a billiary dyskenisia [43].…”

Section: Resultsmentioning

confidence: 99%

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Acute Acalculous Cholecystitis Associated with Epstein–Barr Infection: A Case Report and Review of the Literature

Ntelis

Mazarakis

Sapountzis

et al. 2020

Case Reports in Medicine

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The most common cause of acute cholecystitis (ACC) is cholelithiasis. Acute acalculous cholecystitis (AAC) is well documented in the literature related with critical illness, but viral causes such as cytomegalovirus (CMV) and Epstein–Barr virus (EBV) have also been reported. We present a rare manifestation of EBV infection, reporting a case of a 15-year-old female suffering from acute acalulous cholecystitis, and we review the relevant literature. Clinicians should be aware of this rare complication of EBV infection and properly exclude it in young patients with cholecystitis.

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“…These cases recovered conservatively without surgery or corticosteroids [7]. Upon a literature review, at least 12 cases of AAC caused by EBV have been reported since the year 2016 [4,[8][9][10][11][12][13][14][15][16][17][18]. Eight patients were females and four patients were males.…”

Section: Discussionmentioning

confidence: 99%

Primary Epstein-Barr Virus Infection in an Adolescent Female Complicated by Acute Acalculous Cholecystitis

Young¹,

Lampe

2019

Cureus

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Epstein-Barr Virus (EBV) is estimated to infect greater than 98% of adults worldwide and is one of the most common human viruses. EBV infection can lead to acute infectious mononucleosis characterized by fever, fatigue, malaise, sore throat, and lymphadenopathy. Elevated liver function tests (LFTs) and hepatosplenomegaly may also be present. This infection usually lasts over a period of weeks or months and is self-limited. Infected individuals, however, may suffer rare complications. Acute acalculous cholecystitis (AAC) is an atypical complication of infectious mononucleosis. The case of a young healthy adolescent female with primary EBV infection complicated by AAC is reported. Providers should be aware that many pediatric and adult cases of AAC due to EBV resolve with conservative treatment. Surgical intervention has not been described as necessary or indicated in the context of AAC caused by EBV and should only be considered in severe cases that are not responding to conservative therapy.

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Acute Acalculous Cholecystitis due to primary acute Epstein-Barr virus infection treated with laparoscopic cholecystectomy; a case report

Cited by 13 publications

References 13 publications

Epstein‐Barr virus infection with acute acalculous cholecystitis in previously healthy children

Epstein‐Barr virus infection with acute acalculous cholecystitis in previously healthy children

Acute Acalculous Cholecystitis Associated with Epstein–Barr Infection: A Case Report and Review of the Literature

Primary Epstein-Barr Virus Infection in an Adolescent Female Complicated by Acute Acalculous Cholecystitis

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