Gallbladder Involvement of Henoch-Schönlein Purpura Mimicking Acute Acalculous Cholecystitis

Abstract

Background/Aims: We report the case of a 53-year-old man with fever and severe abdominal pain following an upper respiratory tract infection. Methods/Results: The clinical signs, the laboratory markers, and the ultrasound findings were consistent with acute acalculous cholecystitis and he underwent cholecystectomy. Histologically the gallbladder showed vasculitis and the patient developed postoperatively a purpuric rash of the legs with transient ankle arthritis. Gastroscopy revealed prepyloric ulcers consistent with vasculitis. The patient was diagnosed as having Henoch-Schönlein purpura. Gastric ulcers as well as arthritis disappeared upon treatment with corticosteroids and proton pump inhibitors. Conclusion: Taken together, Henoch-Schönlein purpura can mimic acute cholecystitis and should be considered as a rare differential diagnosis of acute cholecystitis.

Secondary Sclerosing Cholangitis in Critically Ill Patients

“…21–23 Because acute acalculous cholecystitis has also been observed in association with Schönlein–Henoch purpura, antiphospholipid syndrome and lupus erythematosus, an ischemic pathogenesis for AAC is supposed. 24–26 A similar pathogenetic mechanism that could explain the gallbladder involvement is hypothesized for SSC-CIP. In ICU patients, an unexplained cholestasis and the simultaneous appearance of acute acalculous cholecystitis should raise the suspicion of SSC-CIP.…”

Single-organ gallbladder vasculitis: Characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 57 patients

“…41,53,64 In addition, GV has been observed in fewer than 2% of patients with other SV. 46 Occasionally, GV manifesting as acalculous cholecystitis and GB hydrops has been described associated with IgA vasculitis (Henoch-Schönlein) 23,28,35 and Kawasaki disease. 13 SV or SOV may also exist in many other organs such as the aorta, 52 breast, 26 gynecologic organs, 27 and testicular structures.…”

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

“…LCV involving the gallbladder may cause acute acalculous cholecystitis [95,96] as well as marked thickening of the gallbladder wall [97]. Hydrops of the gallbladder has been described with spontaneous resolution [98].…”