Epstein-Barr Virus Causing Clinical Jaundice and Acute Acalculous Cholecystitis in a Previously Healthy 17-Year-Old Girl

Abstract

Patient: Female, 17-year-old Final Diagnosis: Epstein-Barr virus infection Symptoms: Jaundice • malaise • right upper quadrant abdominal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Infectious Diseases Objective: Rare coexistence of disease or pathology Background: Infectious mononucleosis secondary to Epstein-Barr Virus is a common infection in young adults. Infection usually involves a self-limiting course of fevers, sore throat, malaise, and myalgias. Transaminitis is a relatively common complication; clinical jaundice, however, is rare. This case report highlights an uncommon complication of Epstein-Barr Virus infection in which hepatocellular injury led to clinical jaundice as well as radiologic evidence of gallbladder pathology mimicking acute calculous cholecystitis. Case Report: A 17-year-old girl with no prior medical history presented to our Emergency Department 1 week after being diagnosed with infectious mononucleosis. She was hemodynamically stable and her physical exam was notable for scleral icterus with right upper quadrant tenderness and positive Murphy’s sign. Multiple imaging modalities performed showed gallbladder wall thickening without common bile duct dilatation. A hepatobiliary iminodiacetic acid (HIDA) scan showed evidence of hepatocyte dysfunction with normal gallbladder filling. The imaging results obtained in conjunction with her laboratory testing and active infectious mononucleosis infection confirmed the patient’s presentation was a result of her Epstein-Barr virus infection and did not require surgical intervention for cholecystectomy. Conclusions: This case report highlights a rare complication of Epstein-Barr Virus infection and demonstrates the utility of interpreting hepatic function testing in conjunction with relevant imaging modalities in cases of clinical jaundice. By doing so, we were able to conclude the patient’s gallbladder pathology was related to acute acalculous cholecystitis (AAC) and did not warrant surgical intervention. The patient was given supportive care measures and made a full recovery.

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).…”

The footprint of gut microbiota in gallbladder cancer: a mechanistic review

“…Second, primary EBV infection can cause acute acalculous cholecystitis (AAC), especially in young women ( Agergaard and Larsen, 2015 ). A literature search identified 26 cases of acute EBV infection and AAC, 25 of which were in pediatric or adult females ( Agergaard and Larsen, 2015 ; Yesilbag et al., 2017 ; Harvey et al., 2021 ). Third, the first case of EBV-associated mixed gallbladder carcinoma was reported, which manifested a unique phenotype of lymphoepithelioma-like carcinoma and mucinous differentiated adenocarcinoma ( Jain et al., 2021 ).…”

The risk factors of developing acute acalculous cholecystitis concomitant with EBV hepatitis in pediatric population

“…In fact, AAC is recognized to be an atypical nding of EBV infection that may occur insidiously. Despite cases of EBV hepatitis concomitant with AAC have been reported but most of them were literally case reports [10][11][12][13][14][15][16][17][18][19]. EBV was rising as the well-known pathogen of ACC in recent two decades due to the higher association with cholestasis as compared to other herpes viruses [20].…”