• acute acalculous cholecystitis
• cholecystectomy
• prognosis
• rheumatic disease
• viral infection

• Humans
• Conservative Treatment
• Abdomen, Acute
• Acalculous Cholecystitis/complications
• Acalculous Cholecystitis/therapy
• Cholecystectomy
• Cholecystitis, Acute/complications
• Cholecystitis, Acute/surgery
• Rheumatic Diseases

• HAV‐induced AAC
• Hepatitis A virus
• acalculous cholecystitis

Acute acalculous cholecystitis (AAC) is inflammation of the gallbladder without evidence of calculi. Although rarely reported, its etiologies include hepatitis virus infection (e.g., hepatitis A virus, HAV) and adult-onset Still’s disease (AOSD). There are no reports of HAV-associated AAC in an AOSD patient.

Here we report a rare case of HAV infection-associated AAC in a 39-year-old woman who had a history of AOSD. The patient presented with an acute abdomen and hypotension. Elevated hepatobiliary enzymes and a thickened and distended gallbladder without gallstones on ultrasonography suggested AAC, but there were no signs of anemia nor thrombocytopenia. Serological screening revealed anti-HAV IgM antibodies. Steroid treatment did not alleviate her symptoms, and she was referred for laparoscopic cholecystectomy. The resected gallbladder was hydropic without perforation, and her clinical signs gradually improved after surgery.

AAC can be caused by HAV in AOSD patients. It is crucial to search for the underlying etiology for AAC, especially uncommon viral causes.

• Acalculous cholecystitis
• Hepatitis A virus
• Adult-onset Still’s disease
• Acute abdomen
• Cholecystectomy
• Case report

Acute acalculous cholecystitis (AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses (such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.

• Acute acalculous cholecystitis
• Children
• Viral biliary disorders

• Acalculous Cholecystitis/diagnosis
• Acalculous Cholecystitis/epidemiology
• Acalculous Cholecystitis/etiology
• Acalculous Cholecystitis/therapy
• Anti-Bacterial Agents/therapeutic use
• Child
• Cholecystectomy
• Cholecystitis, Acute/epidemiology
• Cholecystitis, Acute/therapy
• Cholecystitis, Acute/virology
• Epstein-Barr Virus Infections/complications
• Epstein-Barr Virus Infections/immunology
• Epstein-Barr Virus Infections/virology
• Gallbladder/immunology
• Gallbladder/surgery
• Gallbladder/virology
• Hepatitis A/complications
• Hepatitis A/immunology
• Hepatitis A/virology
• Hepatitis A Virus, Human/isolation & purification
• Herpesvirus 4, Human/isolation & purification
• Humans
• Incidence
• Risk Factors
• Treatment Outcome

We here report a case of a young, male patient who presented with jaundice and was diagnosed with acalculous cholecystitis during the course of a primary Epstein-Barr Virus (EBV) infection. The coexistence of cholestatic hepatitis and acalculous cholecystitis in patients with infectious mononucleosis is extremely uncommon and only few cases can be found in the literature. Moreover, almost one-fourth of the total reports of this rare entity are coming from Greece. Whether this is a result of physicians' high index of suspicion due to previous reports or a consequence of genetic predisposition is an issue that deserves further investigation in the future. More studies are required in order to clarify the pathophysiological and genetic backgrounds that connect acalculous cholecystitis and EBV infection.

Acute cholecystitis is most frequently concomitant with cholelithiasis, whereas acute acalculous cholecystitis is usually of an infectious aetiology. Among the aetiological factors, Epstein-Barr virus (EBV) infection is also mentioned. The case of a 17-year-old girl is described, hospitalised in the Children's Clinical Hospital, Paediatric Clinic, at the Medical University in Lublin, due to fever, upper abdomen pain lasting for a week, and nausea for several days. Based on the diagnostic – laboratory tests performed and ultrasonographic examination, acute acalculous cholecystitis was diagnosed, taking course with elevated aminotransferase activity and features of cholestasis. Serological tests confirmed an acute infection with Epstein-Barr virus. After 2 weeks of hospitalisation, the patient, receiving conservative treatment, was discharged home in good condition. A follow-up examination performed 2 weeks later did not show deviation from normal.

• Epstein-Barr virus
• acalculous cholecystitis
• children

Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with gangrene, perforation, and empyema. Due to these associated complications, AAC can be associated with high morbidity and mortality. Medical or surgical treatments can be chosen according to the general condition of the patient, underlying disease and agent. Particularly in acute acalculous cholecystitis cases, early diagnosis and early medical treatment have a positive effect on the patient and protect them from surgical trauma. ACC is a rare complication of acute viral hepatitis A. Herein, we present an adult patient of acalculous cholecystitis due to acute viral hepatitis A. She responded to the conservative management.