Acute acalculous cholecystitis in children

Table 1 Reported cases of non-infectious pediatric acute acalculous cholecystitis associated with immune-mediated disorders (2000-2018)

Ref.	Age (yr)	Sex	Comorbidity	Clinical manifestations
Basiratnia et al[13], 2006	10	M	Systemic lupus erythematosus	RUQ pain, fever, nausea, vomiting
Shin et al[14], 2007	5	M	Nephrotic syndrome	Abdominal pain, vomiting
Mendonca et al[15], 2009	12	F	Systemic lupus erythematosus	Abdominal pain, anorexia, weight loss, nausea, vomiting
Lee et al[16], 2014	N/A	N/A	Systemic lupus erythematosus (n = 2); nephrotic syndrome (n = 1)	N/A (patients were included in a large case series of pediatric AAC)
Sanches et al[17], 2014	11	F	Juvenile dermatomyositis	RUQ pain, nausea, vomiting
Ozkaya et al[18], 2016	7	M	Henoch-Shonlein purpura	Abdominal pain, jaundice
Yi et al[19], 2016	N/A	N/A	Kawasaki disease (n = 28)	N/A (patients were included in a large case series of pediatric AAC)

AAC: Acute acalculous cholecystitis; RUQ: Right upper quadrant.

Table 2 Reported cases of pediatric acute acalculous cholecystitis associated with specific infections (2000-2018)

Ref.	Age (yr)	Sex	Comorbidity	Clinical manifestations
Ashley et al[28], 2000	4	M	B. abortus	RUQ pain, fever, constipation, anorexia
Ciftci et al[29], 2001	7	M	HAV	Abdominal pain, fever, jaundice
Lo et al[30], 2002	5	M	Salmonella group D	Abdominal pain, fever, vomiting, diarrhea
Batra et al[31], 2003	12	M	S. aureus	RUQ pain, fever, jaundice, maculopapular rash
Garel et al[32], 2003	4	M	Salmonella spp.	Abdominal pain, fever, vomiting, diarrhea
Saha et al[33], 2005	7	F	P. falciparum	RUQ pain, fever
Axelrod et al[44], 2007	3	F	S. typhi	Abdominal pain, fever, vomiting
Kuttiat et al[35], 2007	8 and 9	M	P. falciparum and P. vivax	RUQ pain, fever, vomiting (P. vivax)
Lagona et al[36], 2007	4	F	EBV	RUQ pain, fever, jaundice, vomiting, anorexia
Anthoine-Milhomme et al[37], 2007	7	F	Plasmodium spp.	Abdominal pain, fever, diarrhea, jaundice
Prassouli et al[38], 2007	13	F	EBV	Abdominal pain, fever, vomiting, jaundice
Gora-Gebka et al[39], 2008	9 and 4	F	EBV + CMV and EBV	RUQ pain, fever, jaundice, enlargement of liver and spleen
Kumar et al[40], 2008	3	F	P. falciparum	Abdominal pain, fever, vomiting
Bouyahia et al[41] 2008	14	M	HAV	Abdominal pain, vomiting, fever
Attilakos et al[42], 2009	5	M	EBV	Fever, jaundice, enlargement of liver and spleen
Sureshet al[43], 2009	2	F	HAV	Abdominal pain, fever, vomiting
Souza et al[44], 2009	16	M	HAV	Abdominal pain, fever, vomiting
Arroud et al[45], 2011	11	M	HAV	Abdominal pain, fever, vomiting, jaundice
Herek et al[46], 2011	9	M	HAV	Abdominal pain, fever, vomiting, jaundice
Prashanth et al[47], 2012	12	F	HAV	Abdominal pain, vomiting
Newcombe et al[48], 2013	9	M	C. burnetii	N/A
Gnassingbe et al[49], 2013	5-13	4 M, 2 F	S. typhi	Mainly abdominal pain, fever and vomiting
Poddighe et al[50], 2014	7	F	EBV	RUQ, fever, vomiting, jaundice, liver enlargement.
Kim et al[51], 2014	10	F	EBV	RUQ pain, fever, cervical lymphadenopathy
Fretzajas et al[52], 2014	11 and 12	F	EBV	Abdominal pain, fever, jaundice, hepatosplenomegaly
Strehle et al[53], 2014	14	F	EBV	Fever, RUQ pain, vomiting, anorexia, eyelid swelling
Suga K et al[54], 2014	6	F	EBV	Abdominal pain, epigastralgia
Alkoury et al[55], 2015	15	F	EBV	Abdominal pain, fever, vomiting
Pawlowska-Kamieniak et al[56], 2015	17	F	EBV	RUQ pain, fever, anorexia
Majdalani et al[56], 2016	16	F	EBV	Abdominal pain, fever, vomiting
Gomes et al[58], 2016	3	M	HHV-6	Abdominal pain, vomiting, generalized maculo-papular skin rash
Ismaili-Jaha et al[59], 2018	1, 2, 4, 10	F, F, F, M	Ascaris lumbricoides	Mainly fever, diarrhea, vomiting
Aguilera-Alonso et al[60], 2018	5	F	P. falciparum	Abdominal pain, fever, jaundice

CMV: Cytomegalovirus; EBV: Epstein-Barr virus; HAV: Hepatitis A virus; HHV: Human herpes virus; RUQ: Right upper quadrant.

Table 3 Main therapeutic approach in the reported cases of pediatric acute acalculous cholecystitis (2000-2018)

Author (etiology, yr, country)	Age (yr)/sex	Surgery	Antibiotic	Observations
Ashley et al[28] (B. Abortus, 2000, United States)	4-M	-	Cotrimoxazole rifampin	Diagnosis through blood culture (initial antibiotic therapy with ampicillin, metronidazole and gentamicin)
Croteau et al[75] (N/A, 2001, United States)	2-M	Laparoscopic cholecystectomy	Second-generation cephalosporin	Removal of gallbladder after AAC recurrence
Lo et al[30] (Salmonella group D, 2002, Taiwan)	5-M	Laparotomic cholecystectomy	Ceftriaxone	Removal of gallbladder for AAC complicated by empyema
Batra et al[31] (S. Aureus, 2003, United States)	12-M	Laparotomic cholecystectomy	Ampicillin/sulbactam Ceftriaxone, metronidazole	AAC developed for bacteriemia during osteomyelitis.
Saha et al[33] (P. Falciparum, 2005, India)	7-F	-	Ceftriaxone	Intravenous quinine as soon as definitive diagnosis was achieved
Basiratnia et al[13] (SLE, 2006, Iran)	10-M	Laparotomic cholecystectomy	Ceftriaxone, metronidazole	High-dose prednisolone for 3 d. Surgical approach due to poor response (not specified)
Kuttiat et al[35] (P. falciparum and P. Vivax, 2007, India)	8-M 9-M	-	Ceftriaxone	Intravenous quinine as soon as definitive diagnosis was achieved
Lagona et al[36] (EBV, 2007, Greece)	4-F	-	-	Only supportive therapy and close follow-up
Anthoine-Milhomme et al[37] (Plasmodium spp., 2007, France/Ivory Coast)	7-F	-	Amoxicillin triamphenicol	Halofantrin was started upon diagnosis
Prassouli et al[38] (EBV, 2007, Greece)	13-F	-	Cefotaxime, tobramicin, metronidazole
Shin et al[14] (Nephrotic syndrome, 2007, South Korea)	5-M	-	Ampicillin, cefotaxime	Deflazacort 60 mg/m2
Gora-Gebkaet al[39] (EBV + CMV and EBV, 2008, Poland)	9-F, 4-F	-	Cefotaxime
Bouyahia et al[41] (HAV, 2008, Tunisia)	14-M	-	Cefotaxime, gentamicin
Suresh et al[43] (HAV, 2009, India)	2-F	-	-
Souza et al[44] (HAV, 2009, Brazil)	16-M	-	-
Mendonca et al[15], (SLE, 2009, Brazil)	12-F	-	-	Concomitant SNC vasculitis findings: treated with high-dose prednisolone for 3 d.
McNaughton et al[76] (N/A, 2010, United States)	14-M	Laparoscopic cholecystectomy	Antibiotics (not specified)
Karkera et al[77] (N/A, 2010, India)	11-M	Laparotomic cholecystectomy	Antibiotics (not specified)	Both patients developed complicated (perforated) AAC
Arroud et al[45] (HAV, 2011, Morocco)	11-M	-	Amoxicillin-clavulanic acid, gentamicin
Herek et al[46] (HAV, 2011, Turkey)	9-M	-	-
Pal K[24], (Type I Diabetes mellitus, 2011, Saudi Arabia)	11-M	Laparoscopic cholecystectomy	Antibiotics (not specified)	Emphysematous AAC associated with secondary appendicitis. Bile bacteriology revealed E. Coli and Ebterococcus spp
Prashanth et al[47] (HAV, 2012, India)	12-F	-	-
Newcombe et al[48] (C. Burnetii, 2013, Australia)	9-M	-	Ampicillin, gentamicin, metronidazole	AAC as probable complication of infection-associated anti-phospholipid syndrome
Shihabuddin et al[22] (Cystic fibrosis, 2013, United States)	10-F	-	Antibiotics (not specified)
Poddighe et al[50] (EBV, 2014, Italy)	7-F	-	Cefotaxime	Patient coming from South-East Asia
Kim et al[51] (EBV, 2014, South Korea)	10-F	-	Antibiotics (not specified)
Strehle et al[53] (EBV, 2014, United Kingdom)	14-F	-	Antibiotics (not specified)
Sanches et al[17] (JDM, 2014, Portugal)	11-F	-	-	high-dose prednisolone for 3 d
Suga et al[54] (EBV, 2014, Japan)	6-F	-	-	Only supportive therapy
Alkoury et al[55] (EBV, 2015, United States)	15-F	-	N/A
Pawlowska-Kamieniak et al[56] (EBV, 2015, Poland)	17-F	-	Antibiotics (not specified)	UDCA, analgesics, and relaxants
Muta et al[78] (N/A, 2015, Japan)	6-M	Laparoscopic cholecystectomy	N/A	Case of eosinophilic cholecysitis without evidence of other eosinophilic disease
Majdalani et al[57] (EBV, 2016, Lebanon)	16-F	-	Ciprofloxacin, metronidazole
Rodà et al[79] (EBV, 2016, Spain)	2-M	-	Ceftriaxone	Concomitant nephrotic syndrome and EBV infection
Özkaya et al[18] (Henoch-Schonlein purpura, 2016, Turkey)	7-M	Laparotomic cholecystectomy	Antibiotics (not specified)
Gomes et al[58] - (HHV-6, 2016, Portugal)	3-M	-	-
Naselli et al[23] (ALL-T, 2017, United Kingdom)	12-M	-	Piperacillin-tazobactam, metronidazole	Neutropenia during chemotherapy (dexamethasone, daunorubicin, vincristine, PEG-asparaginase)
Aguilera-Alonso et al[60] (Plasmodium falciparum, 2018, Spain/Equatorial Guinea)	5-F	-	Clindamycin, cefotaxime, metronidazole	Intravenous quinine as soon as definitive diagnosis was achieved
Ismaili-Jaha et al[59] (Ascaris lumbricoides, Albania, 2018)	1-F, 2-F, 4-F, 10-M	-	Antibiotics (not specified)	Mebendazole
Ng et al[80] (N/A, concomitant pneumonia, 2018, Australia)	7-M	-	Ceftriaxone, metronidazole

AAC: Acute acalculous cholecystitis; CMV: Cytomegalovirus; EBV: Epstein-Barr virus; HAV: Hepatitis A virus; HHV: Human herpes virus; RUQ: Right upper quadrant; UDCA: Ursodeoxycholic acid.