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Tsiakalos A, Schinas G, Karatzaferis A, Rigopoulos EA, Pappas C, Polyzou E, Dimopoulou E, Dimopoulos G, Akinosoglou K. Acalculous Cholecystitis as a Complication of Primary Epstein-Barr Virus Infection: A Case-Based Scoping Review of the Literature. Viruses 2024; 16:463. [PMID: 38543828 PMCID: PMC10974004 DOI: 10.3390/v16030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024] Open
Abstract
Primary Epstein-Barr virus (EBV) infection manifests with diverse clinical symptoms, occasionally resulting in severe complications. This scoping review investigates the rare occurrence of acute acalculous cholecystitis (AAC) in the context of primary EBV infection, with a focus on understanding its prevalence, clinical features, and underlying mechanisms. The study also explores EBV infection association with Gilbert syndrome, a condition that potentially exacerbates the clinical picture. Additionally, a case report of an 18-year-old female presenting with AAC and ascites secondary to EBV infection enhances the review. A comprehensive literature review was conducted, analyzing reported cases of AAC secondary to EBV infection. This involved examining patient demographics, clinical presentations, laboratory findings, and outcomes. The search yielded 44 cases, predominantly affecting young females. Common clinical features included fever, cervical lymphadenopathy, tonsillitis/pharyngitis, and splenomegaly. Laboratory findings highlighted significant hepatic involvement. The review also noted a potential link between AAC in EBV infection and Gilbert syndrome, particularly in cases with abnormal bilirubin levels. AAC is a rare but significant complication of primary EBV infection, primarily observed in young females, and may be associated with Gilbert syndrome. This comprehensive review underscores the need for heightened clinical awareness and timely diagnosis to manage this complication effectively.
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Affiliation(s)
| | - Georgios Schinas
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
| | | | | | | | - Eleni Polyzou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
| | | | - George Dimopoulos
- 3rd Department of Critical Care, Evgenidio Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (E.A.R.); (E.P.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
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2
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Chang C, Wang Y, Shi W, Xu H, Huang X, Jiao Y. Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen? Medicine (Baltimore) 2023; 102:e34662. [PMID: 37656996 PMCID: PMC10476726 DOI: 10.1097/md.0000000000034662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
Patients with acute acalculous cholecystitis (AAC) often present with acute abdominal symptoms. However, recent clinical studies have suggested that some patients with AAC and an acute abdomen, especially when caused by viruses or rheumatic disease, may not require cholecystectomy and that conservative treatment is adequate. Whether cholecystectomy is superior to conservative treatment for patients with AAC presenting with a severe acute abdomen is still uncertain. This was a case series study of AAC-related literature published between 1960 and 2022. In total, 171 cases (104 viral infection-associated AAC and 67 rheumatic disease-associated AAC) were included. The prognoses of patients receiving cholecystectomy or conservative treatment were compared. To account for confounding factors, etiological stratification and logistic regression were performed. The prognosis was similar for patients undergoing cholecystectomy and conservative treatment (P value .364), and virus infection-associated AAC had a better prognosis than rheumatic disease-associated AAC (P value .032). In patients with AAC caused by viruses or rheumatic disease, the acute abdomen can be adequately managed by conservative treatment of the underlying etiology and does not mandate surgical intervention.
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Affiliation(s)
- Chuheng Chang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Youyang Wang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen Shi
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoming Huang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Jiao
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Rein J, Watkins B. Acalculous Cholecystitis in a Seven-Year-Old Girl With Epstein-Barr Virus Infection. Cureus 2021; 13:e19774. [PMID: 34950552 PMCID: PMC8687799 DOI: 10.7759/cureus.19774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/05/2022] Open
Abstract
Epstein-Barr virus (EBV) infection with associated acute acalculous cholecystitis (AAC) has been reported in 18 pediatric patients. Our case is that of a seven-year-old girl with acute EBV infection and associated AAC.
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Affiliation(s)
- Jeffrey Rein
- Pediatrics, Southern Arizona Veterans Affairs (VA) Health Care System, Tucson, USA.,Pediatrics, The University of Arizona, Banner-Diamond Children's Medical Center, Tucson, USA
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Markaki I, Konsoula A, Markaki L, Spernovasilis N, Papadakis M. Acute acalculous cholecystitis due to infectious causes. World J Clin Cases 2021; 9:6674-6685. [PMID: 34447814 PMCID: PMC8362504 DOI: 10.12998/wjcc.v9.i23.6674] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder not associated with the presence of gallstones. It usually occurs in critically ill patients but it has also been implicated as a cause of cholecystitis in previously healthy individuals. In this subgroup of patients, infectious causes comprise the primary etiology. We, herein, discuss the pathophysiological mechanisms involved in AAC, focusing on the infectious causes. AAC associated with critical medical conditions is caused by bile stasis and gallbladder ischemia. Several mechanisms are reported to be involved in AAC in patients without underlying critical illness including direct invasion of the gallbladder epithelial cells, gallbladder vasculitis, obstruction of the biliary tree, and sequestration. We emphasize that multiple pathogenic mechanisms may concurrently contribute to the development of AAC in varying degrees. Awareness of the implicated pathogens is essential since it will allow a more focused examination of the histopathological specimens. In conclusion, additional research and a high degree of clinical suspicion are needed to clarify the complex spectrum of mechanisms that are involved in the pathogenesis of AAC.
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Affiliation(s)
- Ioulia Markaki
- Department of Emergency, General Hospital of Kythira “Trifyllio”, Kythira 80200, Greece
| | - Afroditi Konsoula
- Department of Emergency, General Hospital of Mytilene "Vostaneio", Lesvos 81132, Greece
| | - Lamprini Markaki
- Department of Pediatrics, "Agia Sofia" Children's Hospital, Athens 11527, Greece
| | | | - Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 40235, NRW, Germany
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BONINSEGNA SARA, STORATO SILVIA, RICCARDI NICCOLÒ, SOPRANA MARCO, OLIBONI EUGENIO, TAMAROZZI FRANCESCA, BOCUS PAOLO, MARTINI MARIANO, FLOREANI ANNAROSA. Epstein-Barr Virus (EBV) acute acalculous cholecystitis in an immunocompromised adult patient: a case report and a literature review of a neglected clinical presentation. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E237-E242. [PMID: 34322642 PMCID: PMC8283645 DOI: 10.15167/2421-4248/jpmh2021.62.1.1859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 12/02/2022]
Abstract
Primary Epstein-Barr virus (EBV) infection may present with self-limiting abdominal involvement, characterized by hepatitis with mild elevation of aminotransferases, splenomegaly, and rarely with acute acalculous cholecystitis (AAC). Usually, treatment of EBV related AAC is symptomatic, without the need for surgery. Here, we describe a severe case of AAC occurring as the first manifestation of infectious mononucleosis in a young adult woman, receiving treatment with interleukin 6 receptor (IL-6r) inhibitor for rheumatoid arthritis (RA); moreover, we have performed a review of the literature on EBV-related AAC.
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Affiliation(s)
- SARA BONINSEGNA
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - SILVIA STORATO
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - NICCOLÒ RICCARDI
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
- Correspondence: Niccolò Riccardi, Infectious and Tropical Medicine Specialist, IRCCS Sacro Cuore Don Calabria Hospital - E-mail:
| | - MARCO SOPRANA
- Division of General Medicine, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - EUGENIO OLIBONI
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - FRANCESCA TAMAROZZI
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - PAOLO BOCUS
- Department of Gastroenterology and Endoscopy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - MARIANO MARTINI
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - ANNAROSA FLOREANI
- University of Padova, Italy - IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Acute Acalculous Cholecystitis Due to a Primary Epstein Barr Virus Infection in a Pediatric Patient. Pediatr Rep 2021; 13:86-90. [PMID: 33562159 PMCID: PMC7931023 DOI: 10.3390/pediatric13010011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
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.
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Denouement. Pediatr Infect Dis J 2019; 38:878-879. [PMID: 31306404 DOI: 10.1097/01.inf.0000577640.22353.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Poddighe D, Sazonov V. Acute acalculous cholecystitis in children. World J Gastroenterol 2018; 24:4870-4879. [PMID: 30487697 PMCID: PMC6250923 DOI: 10.3748/wjg.v24.i43.4870] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Vitaliy Sazonov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Pediatric Intensive Care Unit, UMC National Research Center for Mother and Child Health, Astana 010000, Kazakhstan
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Lu YA, Chiu CH, Kong MS, Wang HI, Chao HC, Chen CC. Risk factors for poor outcomes of children with acute acalculous cholecystitis. Pediatr Neonatol 2017; 58:497-503. [PMID: 28499592 DOI: 10.1016/j.pedneo.2016.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/13/2016] [Accepted: 12/30/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is generally considered to be a mild disease in children; however, if left untreated or treated without caution, AAC can lead to severe outcomes, such as death. The objectives of this study were to present the clinical features and identify the predictors of mortality in pediatric AAC. METHODS Patients diagnosed with AAC between 2005 and 2012 were enrolled. AAC was defined by the presence of fever and an echo-proven thickened gallbladder wall exceeding 4 mm. A poor health outcome was defined as death. Further information related to the demographics, clinical manifestations, laboratory results, ultrasound findings, and pathogens present in the AAC patients was also collected. Predictors of mortality were identified by association analyses and confirmed by multivariate logistic regression. RESULTS A total of 147 pediatric AAC patients (male/female = 1.01, mean age = 5.2 years) were included in this retrospective study. The most common clinical presentation was an elevated C-reactive protein level (84%) followed by hepatomegaly (80%) and anorexia (78%). AAC in children was associated with various diseases, including infectious diseases (70%), systemic diseases (13%), and malignancy (11%). Fourteen of the 147 (9.25%) patients died during the study period. The presences of thrombocytopenia, anemia, gallbladder sludge, hepatitis, and/or sepsis plus hepatitis were found to be the important predictors of AAC mortality. CONCLUSIONS The factors associated with AAC mortality were anemia, thrombocytopenia, gallbladder sludge, hepatitis, and sepsis plus hepatitis. These predictors are likely to help clinicians identify patients who are at a high risk of poor prognoses and make appropriate clinical decisions.
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Affiliation(s)
- Yi-An Lu
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Infectious Disease, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-I Wang
- Department of Health Sciences, University of York, York, England, UK
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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10
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Say DS, Chaparro J, Koning JL, Sivagnanam M. Fever and Jaundice in a Previously Healthy Teenager. Clin Pediatr (Phila) 2016; 55:1081-4. [PMID: 27630008 PMCID: PMC5115630 DOI: 10.1177/0009922816667311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Daphne S. Say
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego (San Diego, CA),Rady Children’s Hospital, San Diego (San Diego, CA)
| | - Juan Chaparro
- Division of Infectious Diseases, Department of Pediatrics, University of California, San Diego (San Diego, CA),Rady Children’s Hospital, San Diego (San Diego, CA)
| | - Jeffrey L. Koning
- Department of Radiology, University of California, San Diego (San Diego, CA)
| | - Mamata Sivagnanam
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego (San Diego, CA),Rady Children’s Hospital, San Diego (San Diego, CA)
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Kottanattu L, Lava SAG, Helbling R, Simonetti GD, Bianchetti MG, Milani GP. Pancreatitis and cholecystitis in primary acute symptomatic Epstein-Barr virus infection - Systematic review of the literature. J Clin Virol 2016; 82:51-55. [PMID: 27434148 DOI: 10.1016/j.jcv.2016.06.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/24/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis and acalculous cholecystitis have been occasionally reported in primary acute symptomatic Epstein-Barr virus infection. We completed a review of the literature and retained 48 scientific reports published between 1966 and 2016 for the final analysis. Acute pancreatitis was recognized in 14 and acalculous cholecystitis in 37 patients with primary acute symptomatic Epstein-Barr virus infection. In all patients, the features of acute pancreatitis or acalculous cholecystitis concurrently developed with those of primary acute symptomatic Epstein-Barr virus infection. Acute pancreatitis and acalculous cholecystitis resolved following a hospital stay of 25days or less. Acalculous cholecystitis was associated with Gilbert-Meulengracht syndrome in two cases. In conclusion, this thorough analysis indicates that acute pancreatitis and acalculous cholecystitis are unusual but plausible complications of primary acute symptomatic Epstein-Barr virus infection. Pancreatitis and cholecystitis deserve consideration in cases with severe abdominal pain. These complications are usually rather mild and resolve spontaneously without sequelae.
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Affiliation(s)
- Lisa Kottanattu
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland.
| | - Sebastiano A G Lava
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland; University Children's Hospital, Inselspital, and University of Bern, Bern, Switzerland.
| | - Rossana Helbling
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland.
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland; University Children's Hospital, Inselspital, and University of Bern, Bern, Switzerland.
| | | | - Gregorio P Milani
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy.
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Another Report of Acalculous Cholecystitis in a Greek Patient with Infectious Mononucleosis: A Matter of Luck or Genetic Predisposition? Case Reports Hepatol 2016; 2016:6080832. [PMID: 26885417 PMCID: PMC4738940 DOI: 10.1155/2016/6080832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022] Open
Abstract
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.
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Branco L, Vieira M, Couto C, Coelho MD, Laranjeira C. Acute Acalculous Cholecystitis by Epstein-Barr Virus Infection: A Rare Association. Infect Dis Rep 2015; 7:6184. [PMID: 26753086 PMCID: PMC4693334 DOI: 10.4081/idr.2015.6184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/18/2015] [Accepted: 10/20/2015] [Indexed: 12/17/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is a rare complication of Epstein Barr virus (EBV) infection, with only a few cases reported among pediatric population. This clinical condition is frequently associated with a favorable outcome and, usually, a surgical intervention is not required. We report a 16-year-old girl who presented with AAC following primary EBV infection. The diagnosis of AAC was documented by clinical and ultrasonographic examination, whereas EBV infection was confirmed serologically. A conservative treatment was performed, with a careful monitoring and serial ultrasonographic examinations, which led to the clinical improvement of the patient. Pediatricians should be aware of the possible association between EBV and AAC, in order to offer the patients an appropriate management strategy.
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Affiliation(s)
- Liliana Branco
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
| | - Maria Vieira
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
| | - Cristiana Couto
- Department of Pediatrics, Portuguese Oncology Institute , Porto, Portugal
| | - Maria D Coelho
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
| | - Carla Laranjeira
- Department of Pediatrics, Centro Hospitalar do Alto Ave , Guimarães
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14
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Poddighe D, Tresoldi M, Licari A, Marseglia GL. Acalculous Acute Cholecystitis in Previously Healthy Children: General Overview and Analysis of Pediatric Infectious Cases. Int J Hepatol 2015; 2015:459608. [PMID: 26640715 PMCID: PMC4658411 DOI: 10.1155/2015/459608] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/25/2015] [Accepted: 10/29/2015] [Indexed: 02/06/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder, which does not appear to be associated with the presence of gallstones. AAC is estimated to represent more than 50% of cases of acute cholecystitis in the pediatric population. Although this pathology was initially described in critically ill patients, actually most pediatric cases have been observed during several infectious diseases. Particularly, here we reviewed pediatric infectious acute acalculous cholecystitis and analyzed the pathophysiological and clinical aspects of bacterial and viral forms.
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Affiliation(s)
- Dimitri Poddighe
- Dipartimento di Pediatria, Azienda Ospedaliera di Melegnano, Via Pandina 1, Vizzolo Predabissi, 20070 Milano, Italy
| | - Matteo Tresoldi
- Dipartimento di Chirurgia Generale, Azienda Ospedaliera di Melegnano, Via Pandina 1, Vizzolo Predabissi, 20070 Milano, Italy
| | - Amelia Licari
- Dipartimento di Pediatria, Fondazione IRCCS Policlinico San Matteo, Universita degli Studi di Pavia, Piazzale Golgi 19, 27100 Pavia, Italy
| | - Gian Luigi Marseglia
- Dipartimento di Pediatria, Fondazione IRCCS Policlinico San Matteo, Universita degli Studi di Pavia, Piazzale Golgi 19, 27100 Pavia, Italy
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15
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Hamdy RF, Stein RE, Larru B, Bellah RD, Grossman AB, Hodinka RL, Feemster KA. Gallbladder Wall Thickening in an Adolescent With Acute Mononucleosis: A Case Report and Brief Review of the Literature. J Pediatric Infect Dis Soc 2015; 4:267-71. [PMID: 26407432 DOI: 10.1093/jpids/piu023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/25/2014] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | | | | | - Richard L Hodinka
- Clinical Virology Laboratory, The Children's Hospital of Philadelphia, Pennsylvania Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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16
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Shah S, Schroeder S. A rare case of primary EBV infection causing acute acalculous cholecystitis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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17
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Agergaard J, Larsen CS. Acute acalculous cholecystitis in a patient with primary Epstein-Barr virus infection: a case report and literature review. Int J Infect Dis 2015; 35:67-72. [PMID: 25887813 DOI: 10.1016/j.ijid.2015.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 12/17/2022] Open
Abstract
Epstein-Barr Virus (EBV) infection can lead to infectious mononucleosis syndrome with the typical symptoms of fever, pharyngitis, and lymphadenopathy. Self-limited mild to moderate elevation of liver enzymes and hepatosplenomegaly are common. However, cholecystitis is not usually considered part of a primary EBV infection and ultrasound scan (USS) of the liver and gallbladder is not routinely performed. Acute acalculous cholecystitis (AAC) caused by etiologies other than primary EBV infection is often associated with severe illness and antibiotic treatment and surgery may be needed. We present a case with primary EBV infection and AAC and a literature review. Our patient was a 34-year-old woman with clinical, biochemical and serological signs of primary EBV infection (lymphocytes 7.6×10˄9/l, monocytes 2.6×10˄9/l, positive early antigen IgM test and 14 days later positive early antigen IgG test). During admission, increasing liver function tests indicated cholestasis (alanine aminotransferase 61 U/l, alkaline phosphatase 429 U/l and bilirubin 42μmol/l). USS revealed a thickened gallbladder wall indicating cholecystitis but no calculus. All other microbiological tests were negative. The literature search identified 26 cases with AAC and acute EBV infection; 25 cases involved females. Sore throat was not predominant (six reported this), and all cases experienced gastrointestinal symptoms. Our and previous published cases were not severely ill and recovered without surgical drainage. In conclusion primary EBV infection should be considered in cases of AAC, especially in young women. In cases associated with EBV infection neither administration of antibiotics nor surgical drainage may be indicated.
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Affiliation(s)
- J Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - C S Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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Acute acalculous cholecystitis in a 17-year-old girl with Epstein-Barr virus infection. GASTROENTEROLOGY REVIEW 2015; 10:54-6. [PMID: 25960817 PMCID: PMC4411411 DOI: 10.5114/pg.2015.48998] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/15/2013] [Accepted: 02/12/2013] [Indexed: 12/20/2022]
Abstract
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.
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Gagneux-Brunon A, Suy F, Pouvaret A, Pillet S, Tarantino E, Bouchet D, Fresard A, Cazorla C, Guglielminotti C, Lucht F, Botelho-Nevers E. Acute acalculous cholecystitis, a rare complication of Epstein-Barr virus primary infection: report of two cases and review. J Clin Virol 2014; 61:173-5. [PMID: 25049206 DOI: 10.1016/j.jcv.2014.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 12/29/2022]
Abstract
We described two cases of acalculous cholecystitis (AAC), due to EBV primary infection in two young Caucasian women and we reviewed other reported cases. In contrast with AAC of other etiologies, antibiotics and surgery are not useful in the management of AAC secondary to EBV.
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Affiliation(s)
- Amandine Gagneux-Brunon
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France.
| | - Florence Suy
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
| | - Anne Pouvaret
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Sylvie Pillet
- Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France; Laboratoire de bactériologie et Virologie, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Enrico Tarantino
- Department of General Surgery, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Dorothée Bouchet
- Department of Radiology, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Anne Fresard
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
| | - Céline Cazorla
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Guglielminotti
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédéric Lucht
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious and Tropical Diseases, Universitary Hospital of Saint-Etienne, Saint-Etienne, France; Groupe Immunité des Muqueuses et Agents Pathogènes, EA 3064, Université Jean-Monnet, Université de Lyon, Saint-Etienne, France
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20
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Kim A, Yang HR, Moon JS, Chang JY, Ko JS. Epstein-barr virus infection with acute acalculous cholecystitis. Pediatr Gastroenterol Hepatol Nutr 2014; 17:57-60. [PMID: 24749090 PMCID: PMC3990785 DOI: 10.5223/pghn.2014.17.1.57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 12/22/2022] Open
Abstract
Acute acalculous cholecystitis (AAC) is an inflammation of the gallbladder in the absence of demonstrated stones. AAC is frequently associated with severe systemic inflammation. However, the exact etiology and pathogenesis of AAC still remain unclear. Acute infection with Epstein Barr virus (EBV) in childhood is usually aymptomatic, whereas it often presents as typical infectious mononucleosis symptoms such as fever, cervical lymphadenopathy, and hepatosplenomegaly. AAC may occur during the course of acute EBV infection, which is rarely encountered in the pediatric population. AAC complicating the course of a primary EBV infection is usually associated with a favorable outcome. Most of the patients recover without any surgical treatment. Therefore, the detection of EBV in AAC would be important for prediction of better prognosis. We describe the case of a 10-year-old child who presented with AAC during the course of primary EBV infection, the first in Korea, and review the relevant literature.
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Affiliation(s)
- Ahlee Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Young Chang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. ; Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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21
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Wu WJY, Huang DTN. Primary Epstein-Barr virus-associated acute acalculous cholecystitis and Gianotti-Crosti syndrome. Tzu Chi Med J 2013. [DOI: 10.1016/j.tcmj.2012.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Nagdev A, Ward J. Bedside ultrasound diagnosis of acalculous cholecystitis from epstein-barr virus. West J Emerg Med 2012; 12:481-3. [PMID: 22224143 PMCID: PMC3236129 DOI: 10.5811/westjem.2010.7.1914] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 06/06/2010] [Accepted: 07/12/2010] [Indexed: 11/11/2022] Open
Abstract
Acalculous cholecystitis is thought to occur in patients with a severe systemic illness or during long periods of intravenous nutrition. We discuss a case of acalculous cholecystitis secondary to Epstein-Barr virus detected by bedside ultrasound. We hope to alert clinicians who are actively using bedside ultrasound of an important, yet not commonly discussed, association. [West J Emerg Med. 2011;12(4):
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Affiliation(s)
- Arun Nagdev
- Alameda County Medical Center-Highland General Hospital, Department of Emergency Medicine, Oakland, California; University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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A Case of Epstein-Barr Virus Infection with Gall Bladder and Common Bile Duct Stones in an Otherwise Healthy Child. Pediatr Gastroenterol Hepatol Nutr 2012. [DOI: 10.5223/pghn.2012.15.1.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Daffinoti E, Tavera I, del Río A, Cervera C. Acalculous cholecystitis during infectious mononucleosis in a young male patient. Enferm Infecc Microbiol Clin 2011; 29:474-6. [DOI: 10.1016/j.eimc.2011.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 02/10/2011] [Accepted: 02/11/2011] [Indexed: 01/31/2023]
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Arya SO, Saini A, El-Baba M, Salimnia H, Abdel-Haq N. Epstein Barr virus-associated acute acalculous cholecystitis: a rare occurrence but favorable outcome. Clin Pediatr (Phila) 2010; 49:799-804. [PMID: 20356920 DOI: 10.1177/0009922810363729] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Iaria C, Leonardi MS, Fabiano C, Cascio A. Acalculous cholecystitis during the course of acute Epstein–Barr virus infection and Gilbert's syndrome. Int J Infect Dis 2009; 13:e519-20. [DOI: 10.1016/j.ijid.2009.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 01/28/2009] [Indexed: 10/20/2022] Open
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Yang HN, Hong KW, Lee JS, Eom JS. A case of acute cholecystitis without cholestasis caused by Epstein-Barr virus in a healthy young woman. Int J Infect Dis 2009; 14:e448-9. [PMID: 19700358 DOI: 10.1016/j.ijid.2009.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 06/02/2009] [Indexed: 11/16/2022] Open
Abstract
Epstein-Barr virus (EBV) is known to be one of the causes of viral hepatitis, but its association with cholecystitis is known to be rare. Cholestasis by EBV-induced hepatitis might be a cause of acute cholecystitis in all of the recently reported cases. In contrast, we experienced the case of a 20-year-old woman who was infected with EBV and presented with acute cholecystitis without cholestasis.
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Affiliation(s)
- Ha Na Yang
- Department of Internal Medicine, Kandong Sacred Heart Hospital, Hallym University Medical Center, 150 Seongnae-gil, Gil-dong, Gangdong-Gu, Seoul, Republic of Korea
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Attilakos A, Prassouli A, Hadjigeorgiou G, Lagona E, Kitsiou-Tzeli S, Galla A, Stasinopoulou A, Karpathios T. Acute acalculous cholecystitis in children with Epstein-Barr virus infection: a role for Gilbert's syndrome? Int J Infect Dis 2008; 13:e161-4. [PMID: 19008138 DOI: 10.1016/j.ijid.2008.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 08/23/2008] [Indexed: 02/08/2023] Open
Abstract
Acute acalculous cholecystitis (AAC) in association with acute Epstein-Barr virus (EBV) infection has rarely been described in childhood. In the literature, there are only four reported pediatric cases of AAC associated with isolated primary EBV infection. We present two cases (one new, one retrospectively reviewed) of children with Gilbert's syndrome (GS) who presented with AAC during the course of primary EBV infection. Antibiotics were not used and AAC subsided gradually as the infection regressed. The co-occurrence of GS might have played a contributory role in the pathogenesis of AAC during acute EBV infection.
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Cholongitas E, Katsogridakis K, Dasenaki M. Acalculous cholecystitis during the course of acute Epstein-Barr virus infection. Int J Infect Dis 2008; 13:e129-30. [PMID: 18845463 DOI: 10.1016/j.ijid.2008.06.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 06/12/2008] [Indexed: 11/16/2022] Open
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30
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Miloh T, Magid M, Yurovitsky A, Strauchen J, Arnon R, Kerkar N, Rosenberg H, Joashi U, Bhojwani D. T-cell PTLD presenting as acalculous cholecystitis. Pediatr Transplant 2008; 12:717-20. [PMID: 18798362 DOI: 10.1111/j.1399-3046.2007.00843.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report a five-yr-old child, presenting three yr after heart transplant with acalculous cholecystitis. Histology revealed EBV negative T-cell PTLD. The disease involved the gallbladder, liver, lungs, and mesenteric lymph nodes. He was treated with chemotherapy, went into remission, but relapsed after 11 months and died.
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Affiliation(s)
- Tamir Miloh
- Departments of Pediatric Hepatology, Mount SinaiHospital, New York, NY 10029, USA.
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Iaria C, Arena L, Di Maio G, Fracassi MG, Leonardi MS, Famulari C, Cascio A. Acute acalculous cholecystitis during the course of primary Epstein-Barr virus infection: a new case and a review of the literature. Int J Infect Dis 2008; 12:391-5. [PMID: 18083615 DOI: 10.1016/j.ijid.2007.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 10/26/2007] [Accepted: 10/30/2007] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe a case of acute acalculous cholecystitis occurring in the course of primary Epstein-Barr virus (EBV) infection. METHODS The clinical features of the case were analyzed and compared to those of three other similar cases reported in the international literature. RESULTS All cases occurred in European females with cholestatic hepatitis, presented with gallbladder wall thickening, and recovered uneventfully without the need for surgical intervention. CONCLUSIONS Acute acalculous cholecystitis may occur during the course of acute EBV infection, especially in patients with cholestatic hepatitis. Clinicians should be aware of the possible involvement of the gallbladder during EBV infection to avoid unnecessary invasive procedures or the overuse of antibiotics.
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Affiliation(s)
- Chiara Iaria
- AILMI (Associazione Italiana per la Lotta contro le Malattie Infettive; Italian Association for the Control of Infectious Diseases), University of Messina, Messina, Italy
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Gora-Gebka M, Liberek A, Bako W, Szarszewski A, Kamińska B, Korzon M. Acute acalculous cholecystitis of viral etiology--a rare condition in children? J Pediatr Surg 2008; 43:e25-7. [PMID: 18206441 DOI: 10.1016/j.jpedsurg.2007.10.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acute acalculous cholecystitis (AAC) comprises 5% to 10% of all cases of acute cholecystitis in adults and appears to be even less frequently diagnosed in children. The diagnosis of AAC is established upon some clinical, laboratory, and ultrasonographic findings, which may sometimes be ambiguous and confusing especially in children. Diagnostic difficulties may result in either delayed diagnosis or unnecessary surgical intervention. Acute cholecystitis owing to viral infectious factors is reported to be extremely rare. The aim of the article is to demonstrate 2 cases of AAC as a clinical presentation of both Epstein-Barr virus and cytomegalovirus infection in children.
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