Acute Acalculous Cholecystitis from Infection with Epstein–Barr Virus in a Previously Healthy Child: A Case Report

Abstract

Background: Acute cholecystitis is the acute inflammation of the gallbladder. In adults it is most frequently caused by a gallstone(s) obstructing outflow from the cystic duct, leading to gallbladder distention and edema with eventual development of biliary stasis and bacterial overgrowth, often requiring operative management. However, in children acalculous cholecystitis is more common and is often the result of an infectious process. Case Report: Here we present a case of acute acalculous cholecystitis caused by infection with Epstein-Barr virus in an otherwise healthy three-year-old male. Conclusion: Acalculous cholecystitis is an uncommon but potentially significant complication of Epstein-Barr virus infection in the pediatric population. Emergency providers should consider this diagnosis in any child being evaluated for EBV with the complaint of abdominal pain.

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.…”

“…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. Our case demonstrates the value of considering EBV in the differential diagnosis of pediatric acalculous cholecystitis, with subsequent avoidance of unnecessary and potentially harmful interventions such as cholecystectomy or antibacterial…”

“…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).…”

Coronavirus Disease and Abdominal Pain: Mechanism, Diagnostic, and Treatment

“…Before the COVID-19 pandemic, few studies have focused on the correlation between viral infections (cytomegalovirus, Epstein-Barr virus, hepatitis A virus, and human herpes virus) and acalculous cholecystitis in children [24], [25], [26], [27]. According to these studies, diagnosis of acute cholecystitis may be challenging.…”