A rare case of primary EBV infection causing acute acalculous cholecystitis

Abstract

a b s t r a c tPrimary EpsteineBarr Virus (EBV) infection in children is common and frequently asymptomatic. While symptomatic patients typically present with features of infectious mononucleosis, a rare complication of primary EBV is acute acalculous cholecystitis. A 6 year old previously healthy boy presented with 6 days of low-grade fevers, non-bloody non-bilious vomiting, and periumbilical pain. Based on clinical, laboratory, and radiographic evidence, the patient was diagnosed with acute acalculous cholecystitis due to a primary EBV infection. The patient improved with supportive therapy and remained asymptomatic at follow-up. Overall, clinicians should consider EBV infection in the setting of multi-organ disease and blood dyscrasia. Furthermore, while the pathogenesis of EBV cholecystitis is still unclear, it is important to note that these patients may improve with supportive treatment and do not require surgical intervention.Ó 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).EpsteineBarr Virus (EBV) is a ubiquitous herpes virus that is generally spread among young children through salivary contact. Unlike adolescents, who typically develop features of infectious mononucleosis (IM) [1], primary EBV infections are frequently asymptomatic in children. When symptoms do occur, children present with a variety of manifestations including otitis media, diarrhea, abdominal complaints, upper respiratory infection, and infectious mononucleosis [2]. EBV can affect virtually any organ system, and a diverse range of diseases have been associated with the virus including pneumonia, pancreatitis, thrombocytopenia, myositis, glomerulonephritis and meningoencephalitis [3]. Here, we report a rare presentation of acute acalculous cholecystitis secondary to EBV infection in the pediatric population. Case reportA 6 year old previously healthy boy presented to the ED with 6 days of low-grade fevers (T max ¼ 38 C), fatigue, and periumbilical pain. During this time, his pediatrician had obtained a rapid Strep throat swab which was negative. On the day of admission, his pain had increased in severity and migrated to the right lower quadrant.He endorsed two episodes of non-bloody, non-bilious emesis, darker urine despite good fluid intake, and no changes in skin or stool.In the ED, he was afebrile with normal vitals. Physical exam revealed tenderness to palpation in the right lower quadrant, palpable liver edge with a positive Murphy's sign, and a palpable spleen. His labs were remarkable for leukocytosis with a lymphocytic predominance (18,220 WBC/mL, 80% lymphocytes), thrombocytopenia (73,000/mL), elevated GGT (180 IU/L), transaminitis (AST 135, ALT 331), elevated alkaline phosphatase (569 IU/L), and hyperbilirubinemia (2.3 mg/dL, 1.5 mg/dL direct). Amylase, lipase, LDH, and uric acid were within normal limits, and blood and urine cultures were negative.Right upper and lower quadrant ultrasounds were obtained and showed ma...

Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen?

“…After identifying 671 articles, 153 articles involving 171 cases were eligible: 104 viral infection and 67 rheumatic disease AAC patients. [8,11–162] Viral infection types included: Epstein Barr virus, hepatitis virus, dengue virus, SARS-CoV-2 (COVID-19), human immunodeficiency virus, and cytomegalovirus. Rheumatic diseases included: systemic lupus erythematosus, adult-onset Still disease, Henoch-Schönlein purpura, polyarteritis nodosa, Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis), microscopic polyangiitis, temporal arteritis, Wegener granulomatosis (granulomatosis with polyangiitis), Kawasaki syndrome, systemic juvenile idiopathic arthritis, and juvenile dermatomyositis (Table 1).…”

Condition of Lipid Peroxide Oxidation and Antioxidant System in Patients With Infectious Mononucleosis

“…Other clinical manifestations are possible in addition to the triad of symptomslymphadenopathy, tonsillitis, hepatosplenomegaly in case of IM, that are associated with heart damage (myocardium, pericardium, coronary arteries), central and peripheral nervous system (meningitis, meningoencephalitis), kidney (nephritis), pancreatitis orchites and others [4][5][6].…”