Case report: chronic acalculous cholecystitis preceded by Coxsackievirus B4 infection

Abstract

A 41-year-old female presented with an 8-month history of right upper quadrant pain, exacerbated by ingestion of saturated fats. The patient was positive for antibodies to Coxsackievirus serotype B4, established by an investigation incited by an acute episode of pleurodynia 8 months before the current presentation. Imaging studies including a hepatobiliary iminodiacetic acid scan showed no gallbladder structural or functional abnormalities. Laboratory studies indicated pancreatic enzyme insufficiency associated with below-normal lipase and amylase levels. Patient symptomology was consistent with cholecystitis with positive Murphy’s sign, so cholecystectomy was recommended. Post-surgery pathological report confirmed chronic acalculous cholecystitis. Patient demonstrated full recovery, indicated by return of normal pancreatic enzymes levels and resolution of abdominal pain.

Late dumping syndrome preceded by Coxsackievirus B4 infection and cholecystectomy

“…However, nonsurgical risk factors for DS have been identified, such as vagal nerve damage, pancreatic dysfunction and complications of diabetes, as well as viral infections including SARS-CoV2 and Enteroviruses. These infections have been implicated as triggers for pancreatitis and gastrointestinal motility disorders [ 2 , 6 , 7 ]. Coxsackievirus serotype B4 (CVB4), which binds to host coxsackievirus and adenovirus receptors (CARs) and decay-accelerating factor (DAF) receptors, has been shown to cause localized damage to various cells including intestinal epithelial, β-islet, pleural muscular and neuronal cells, leading to diverse clinical manifestations.…”