Acute acalculous cholecystitis in children with Epstein–Barr virus infection: a role for Gilbert's syndrome?

Attilakos, Achilleas; Prassouli, Alexia; Hadjigeorgiou, George; Lagona, Evagelia; Kitsiou-Tzeli, Sofia; Galla, A; Stasinopoulou, Anastasia; Karpathios, Themistocles

doi:10.1016/j.ijid.2008.08.009

Cited by 46 publications

(48 citation statements)

References 19 publications

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“…Indeed, a mild increase of liver enzymes and abdominal pain is usually noted in around 80% of cases. Conversely, jaundice and hepatitis with moderate-severe alteration of plasma liver enzymes (defined by more than 10 times normal values) are described in less than 5% of symptomatic EBV infections 4 5…”

Section: Discussionmentioning

confidence: 99%

Acute acalculous cholecystitis associated with severe EBV hepatitis in an immunocompetent child

et al. 2014

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SUMMARYAcute acalculous cholecystitis (AAC) is an inflammation of the gallbladder in the absence of demonstrated stones, which is rarely seen in paediatric population. The diagnosis is accomplished mainly through abdominal ultrasonography in the appropriate but usually nonspecific clinical picture. Complicated cases need surgical intervention; the medical management is mainly constituted by supportive and antibiotic therapy, as most AAC are observed in the setting of systemic bacterial or parasitic infections. However, AAC has been rarely reported in association with Epstein-Barr virus (EBV) infection, where the gastrointestinal involvement is often mild and thus unrecognised. We report a case of EBVrelated AAC associated with unusually severe hepatitis in an immunocompetent and otherwise healthy patient. We describe its benign clinical course, despite the serious liver impairment, by a medical management characterised by the prompt discontinuation of broadspectrum antibiotics, as soon as EBV aetiology is ascertained, and by the appropriate analgesia and fluid resuscitation. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

Acute acalculous cholecystitis associated with severe EBV hepatitis in an immunocompetent child

et al. 2014

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“…Dehydration may cause cholecystitis due to increased bile viscosity. Two cases of EBV-related AAC with Gilbert's syndrome were recently reported from Greece (9). In the present patient, UGTA gene analysis was not performed because jaundice did not appear.…”

Section: Discussionmentioning

confidence: 85%

A case of acute acalculous cholecystitis complicated by primary Epstein-Barr virus infection

et al. 2014

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“…The contribution of Gilbert's syndrome to gallbladder stone formation even in patients without hemolytic conditions is also known (9). More recently, an association of Gilbert syndrome with EBV induced cholestasis which was also reported in children with acute acalculous cholecystitis due to EBV infection (10). It is therefore evident that although Gilbert syndrome is an innocent condition, it can exaggerate the clinical manifestations of indirect hyperbilirubinemia as well as cholestasis of other clinical disorders.…”

Section: Discussionmentioning

confidence: 88%

Severe Jaundice in Two Children with Kawasaki Disease: A Possible Association with Gilbert Syndrome

et al. 2012

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Kawasaki disease is a systemic vasculitis, mainly encountered in children. It may affect any organ. Acute cholestasis and severe obstructive jaundice is an atypical manifestation of the disease. We herein present two children with Kawasaki disease and severe direct hypebilibirunemia who also were homozygous and heterozygous respectively for the (TA)7 promoter polymorphism of Gilbert syndrome. Intravenous immunoglobulin was administered to both patients at the acute phase of the disease and the fever remitted within 24 hr following the immunoglobulin administration. Furthermore oral aspirin at a dose of 80-100 mg/kg/24 hr was also given. The first child did not develop any coronary ectasia or aneurysm, whereas dilation of the right coronary artery was identified in the second child, one month after the disease onset. We discuss the possible contribution of Gilbert syndrome to the development of jaundice in our patients.

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Acute acalculous cholecystitis in children with Epstein–Barr virus infection: a role for Gilbert's syndrome?

Cited by 46 publications

References 19 publications

Acute acalculous cholecystitis associated with severe EBV hepatitis in an immunocompetent child

Acute acalculous cholecystitis associated with severe EBV hepatitis in an immunocompetent child

A case of acute acalculous cholecystitis complicated by primary Epstein-Barr virus infection

Severe Jaundice in Two Children with Kawasaki Disease: A Possible Association with Gilbert Syndrome

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