Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults—Case Report and Review of the Literature

Abstract

Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics.

Acute Acalculous Cholecystitis Associated with Epstein–Barr Infection: A Case Report and Review of the Literature

“…Clinical presentation, laboratory and imaging findings, and complications and outcomes of EBV-related AAC have been reviewed extensively in the past in a couple of reviews [23,30]. Abdominal pain remains the most common symptom.…”

Epstein-Barr Virus-induced Jaundice

“…9,12 Once the diagnosis of EBV is made, further workup is generally not warranted. 1,2 Treatment of uncomplicated infectious mononucleosis usually requires only symptomatic treatment with antipyretics, hydration, and rest. 1,2,6 Often patients may experience abdominal pain, which may in part be due to splenomegaly.…”

“…1,2 Treatment of uncomplicated infectious mononucleosis usually requires only symptomatic treatment with antipyretics, hydration, and rest. 1,2,6 Often patients may experience abdominal pain, which may in part be due to splenomegaly. 6 If splenomegaly is present, it is prudent to warn the patient against Clinical Practice and Cases in Emergency Medicine Herold et al…”

“…Elevations in liver transaminases are not uncommon with EBV infection, but are usually transient and rarely progress to fulminant hepatitis. 1,2 However, significant cholestasis and jaundice are rare complications with an incidence of less than 5%. 3,4,5…”

Primary Epstein-Barr Virus Infection in an Adolescent Female Complicated by Acute Acalculous Cholecystitis

“…These cases recovered conservatively without surgery or corticosteroids [7]. Upon a literature review, at least 12 cases of AAC caused by EBV have been reported since the year 2016 [4,[8][9][10][11][12][13][14][15][16][17][18]. Eight patients were females and four patients were males.…”