Acute Acalculous Cholecystitis Due to a Primary Epstein Barr Virus Infection in a Pediatric Patient

Abstract

Epstein–Barr virus (EBV) is estimated to infect more than 98% of adults worldwide and is one of the most common human viruses. Acute acalculous cholecystitis (AAC) of the gallbladder is an atypical complication of infectious mononucleosis caused by EBV. Conservative management has been described in the context of AAC caused by EBV. A surgical approach must be considered in the case of acute complications such as perforation or gallbladder gangrene. We present the case of a 10-year-old female patient with AAC due to infectious mononucleosis syndrome caused by primary EBV infection.

The risk factors of developing acute acalculous cholecystitis concomitant with EBV hepatitis in pediatric population

“…A total of 20 patients in the AAC group and 19 patients in the non-AAC groups are administered with antibiotics initially due to persistent fever in our study, and the treatment will be ceased when the serology is positive for EBV infection or typical presentation of EBV infection is later observed clinically. To date, a total of 30 pediatric cases with EBV-associated AAC were reported, including 24 cases that had been presented by Leganés et al [13] and 6 cases were further updated and recorded in Table 4. As shown in these reports, antibiotics were inevitably prescribed if prolonged fever and secondary bacterial infection were suspected clinically.…”

“…In fact, AAC is recognized to be an atypical nding of EBV infection that may occur insidiously. Despite cases of EBV hepatitis concomitant with AAC have been reported but most of them were literally case reports [10][11][12][13][14][15][16][17][18][19]. EBV was rising as the well-known pathogen of ACC in recent two decades due to the higher association with cholestasis as compared to other herpes viruses [20].…”

Acalculous Cholecystitis in a Seven-Year-Old Girl With Epstein-Barr Virus Infection

“…Clinical evidence of AAC, however, is not common. There have been eighteen reported cases of pediatric patients with symptomatic EBV-associated AAC [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] although radiographic stigmata may be found in up to 25% of cases of pediatric acute EBV [18]. Surgical and antibacterial therapy have been proposed [6] but no reports of adverse outcome have been associated with expectant management alone.…”

“…It can have a wide range of manifestations, from asymptomatic to systemic, severe disease. Since first being reported in 2007 [1], there have been reports of 17 additional pediatric patients with acute acalculous cholecystitis (AAC) as a result of EBV infection [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. We present an additional case in which AAC was the clinically dominant manifestation of acute EBV mononucleosis.…”

Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen?

“…After identifying 671 articles, 153 articles involving 171 cases were eligible: 104 viral infection and 67 rheumatic disease AAC patients. [8,11–162] Viral infection types included: Epstein Barr virus, hepatitis virus, dengue virus, SARS-CoV-2 (COVID-19), human immunodeficiency virus, and cytomegalovirus. Rheumatic diseases included: systemic lupus erythematosus, adult-onset Still disease, Henoch-Schönlein purpura, polyarteritis nodosa, Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis), microscopic polyangiitis, temporal arteritis, Wegener granulomatosis (granulomatosis with polyangiitis), Kawasaki syndrome, systemic juvenile idiopathic arthritis, and juvenile dermatomyositis (Table 1).…”