Epstein Barr virus infection and acalculous cholecystitis, a rare association in a pediatric patient

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

Published Dec 30, 2015
DOI: https://doi.org/10.22551/2015.08.0204.10059
Laura-Mihaela Trandafir Doina Mihailă Mădălina Ionela Chiriac Ioan Sârbu Carmen Iulia Ciongradi

Abstract

Acute acalculous cholecystitis associated with Epstein Barr virus (EBV) infection is a known entity, as opposed to the extremely rare cases of cystic duct stenosis secondary to EBV- related inflammation. The authors present the case of a 10-year-old male patient admitted with altered general state, anorexia, painful and distended abdomen. The patient had a history of EBV acute hepatitis two years prior to the current presentation, diagnosed based on clinical examination (fever, vomiting, and severe pain of right upper abdominal quadrant), and abdominal ultrasound revealing acute acalculous cholecystitis with gallbladder hydrops; still no indication for surgical treatment was made. The clinical outcome was favorable, but during those two years he suffered two episodes of chronic acalculous cholecystitis exacerbation, which required a MRI examination, indicating gallbladder hydrops and narrowing of terminal segment of the cystic duct (secondary inflammatory processes). The biological investigations revealed cholestasis, hepatocytolysis and inflammatory syndrome and the abdominal-ultrasound indicates an acalculous gallbladder and gallbladder hydrops. After cholecystectomy, the histopathological examination revealed chronic inflammation of the gallbladder wall, setting the diagnosis of exacerbation of chronic acalculous cholecystitis. Particularly for the case is the development of cystic duct stenosis, after the EBV acute infection. The clinical and laboratory outcome (monitored after 1, 3, 6, and 12 months) was favorable.

##plugins.themes.bootstrap3.article.details##

Keywords

acalculous cholecystitis, Epstein - Barr virus, infection, gallbladder, hydrops, child, cholecystectomy

References
1. Gora-Gebka M, Liberek A, Bako W, Szarszewski A, Kamińska B, Korzon M. Acute acalculous cholecystitis of viral etiology-a rare condition in children? J Ped Surg 2008; 43:E25-E27.
2. Iaria C, Arena L, Di Maio G, et al. Acute acalculous cholecystitis during the course of primary Epstein-Barr virus infection: a new case and a review of the literature. Int J Inf Dis 2008; 12:391-395.
3. Attilakos A, Prassouli A, Hadjigeorgiou G, et al. Acute acalculous cholecystitis in children with Epstein-Barr virus infection: a role for Gilberts syndrome? Int J Inf Dis 2009; 13:e161-e164.
4. Kang S-J, Yoon K-H, Hwang J-B. Epstein-Barr virus infection with acute pancreatitis associated with cholestatic hepatitis. Pediatr Gastroenterol Hepatol Nutr 2013; 16(1):61-64.
5. Park JH, Noh JC, Park HM, et al. A case of Epstein-Barr virus infection with gall bladder and common bile duct stones in an otherwise healthy child. Pediatr Gastroenterol Hepatol Nutr 2012; 15(1):57-61.
6. Shreders A, Michie C. Acalculous cholecystitis in 14-year old boy with no predisposing factors. The West London Medical Journal 2010; l2(2):11- 14.
7. Prassoulia A, Panagiotoua J, Vakakib M et al. Acute acalculous cholecystitis as the initial presentation of primary Epstein-Barr virus infection. J Ped Surg 2007; 42:E11-E13.
8. Yang SI, Geong JH, Kim JY. Clinical characteristics of primary Epstein Barr virus hepatitis with elevation of alkaline phosphatase and γ-glutamyltransferase in children. Yonsei Med J 2014; 55(1):107-112.
9. Nagdev A, Ward J. Bedside Ultrasound diagnosis of acalculous cholecystitis from Epstein-Barr virus. West J Emerg Med 2011; 12(4):481–483.
10. Rumley TO, Rodgers BM. Hydrops of the gallbladder in children. J Ped Surg 1983; 18(2):138-40.
11. Shaffer EA. Gallbladder disease. In: Walker WA, Durie PR, Amilton JR, et al. Pediatric Gastrointestinal Disease. 3-rd ed. B.C. Decker Inc 2000. Chapter 65. Pg: 1291-1311.
12. Schwarz SM, Hebra A. Pediatric Cholecystitis. 2015. [http://emedicine.medscape.com/article/927340-overview available at 12/28/2015]
13. Jeo CJ. Shackelfords Surgery of the alimentary tract. Vol II. Sixth edition. Philadelphia: Saunders Elsevier, 2007.
14. Parisi GF, Di Dio G, Franzonello C, et al. Liver disease in cystic fibrosis: An Update. Hepat Mon 2013; 13(8):e11215.
15. Poddighe D, Cagnoli G, Mastricci N, Bruni P. Acute acalculous cholecystitis associated with severe EBV hepatitis in an immunocompetent child. BMJ Case Rep 2014.
16. Hamdy RF, Stein RE, Larru B, et al. Gallbladder wall thickening in an adolescent with acute mononucleosis: A case report and brief review of the literature. JPIDS 2014; 1-5.
How to Cite
Trandafir, L.-M., Mihailă, D., Chiriac, M. I., Sârbu, I., & Ciongradi, C. I. (2015). Epstein Barr virus infection and acalculous cholecystitis, a rare association in a pediatric patient. Archive of Clinical Cases, 2(4), Arch Clin Cases 2015; 2(4):252-256. https://doi.org/10.22551/2015.08.0204.10059
Issue
Vol. 2 No. 4 (2015)
Section
Case Reports

Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.

Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.

Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.

How to Cite

Trandafir, L.-M., Mihailă, D., Chiriac, M. I., Sârbu, I., & Ciongradi, C. I. (2015). Epstein Barr virus infection and acalculous cholecystitis, a rare association in a pediatric patient. Archive of Clinical Cases, 2(4), Arch Clin Cases 2015; 2(4):252-256. https://doi.org/10.22551/2015.08.0204.10059