SARS-CoV-2 infection presenting as acute acalculous cholecystitis

A Rare Case of COVID-19 Presenting as Acalculous Cholecystitis

“…According to National Institute of Health (NIH) guidelines on the severity of COVID-19, the patient initially presented as asymptomatic because the patient tested positive for COVID but had “no symptoms consistent with COVID-19.” Later, the patient was classified as having a mild illness, as she had a productive cough but did not have the typical findings of “shortness of breath, dyspnea, or abnormal chest imaging” [ 8 ]. Upon literature review, we found very few cases of non-critically ill patients with COVID-19 infections without pneumonia with initial presentation of acalculous cholecystitis [ 9 , 10 ]. Our patient is unique because even in the rare cases reports of patients who developed acalculous cholecystitis in the setting of COVID-19, most patients had severe COVID illness, unlike our patient [ 11 ].…”

“…Coronavirus has a tropism for angiotensin-converting enzyme 2 (ACE2) receptors, which are abundant in the epithelium of the gallbladder. The virus enters the cells through interaction with the ACE2 receptor, and the virus has been isolated from previously reported cases of COVID-19 presenting as acute acalculous cholecystitis [ 9 ]. The exact mechanism is unknown, but “pathologically, in patients with acalculous cholecystitis, endothelial injury, gallbladder ischemia, and stasis lead to concentration of bile salts, gallbladder distension, and eventually necrosis of the gallbladder tissue” [ 12 ].…”

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).…”