Hepatitis A virus-associated acute acalculous cholecystitis in an adult-onset Still’s disease patient: A case report and review of the literature

Abstract

BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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

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

Core Tip: Acute acalculous cholecystitis (AAC) can be caused by hepatitis A virus (HAV) infection or adult-onset Still’s disease (AOSD). Cholestasis is more likely to occur in HAV-associated AAC, whereas hematological complications are more common in AOSD-associated AAC. When AAC cannot be explained by AOSD, it is necessary to find other causes of AAC. An acute abdomen caused by HAV-related AAC requires careful consideration of the surgical necessity, since most cases are self-limiting and gallbladder perforation is rare.