Chang CH, Wang YY, Jiao Y. Hepatitis A virus-associated acute acalculous cholecystitis in an adult-onset Still’s disease patient: A case report and review of the literature. World J Clin Cases 2023; 11(6): 1410-1418 [PMID: 36926135 DOI: 10.12998/wjcc.v11.i6.1410]
Corresponding Author of This Article
Yang Jiao, MD, Associate Professor, Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing 100730, China. jiaoy@pumch.cn
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 26, 2023; 11(6): 1410-1418 Published online Feb 26, 2023. doi: 10.12998/wjcc.v11.i6.1410
Hepatitis A virus-associated acute acalculous cholecystitis in an adult-onset Still’s disease patient: A case report and review of the literature
Chu-Heng Chang, You-Yang Wang, Yang Jiao
Chu-Heng Chang, You-Yang Wang, Yang Jiao, Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Author contributions: Jiao Y conceived this study; Chang CH and Wang YY drafted the manuscript; Jiao Y critically revised the manuscript; all authors have revised the final version of the manuscript and approved it for publication.
Supported bythe National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-A-017 and No. 2022-PUMCH-B-045; and CAMS Innovation Fund for Medical Sciences from Chinese Academy of Medical Sciences, No. 2021-I2M-1-062.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yang Jiao, MD, Associate Professor, Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Beijing 100730, China. jiaoy@pumch.cn
Received: November 11, 2022 Peer-review started: November 11, 2022 First decision: January 12, 2023 Revised: January 14, 2023 Accepted: February 8, 2023 Article in press: February 8, 2023 Published online: February 26, 2023
Abstract
BACKGROUND
Acute acalculous cholecystitis (AAC) is inflammation of the gallbladder without evidence of calculi. Although rarely reported, its etiologies include hepatitis virus infection (e.g., hepatitis A virus, HAV) and adult-onset Still’s disease (AOSD). There are no reports of HAV-associated AAC in an AOSD patient.
CASE SUMMARY
Here we report a rare case of HAV infection-associated AAC in a 39-year-old woman who had a history of AOSD. The patient presented with an acute abdomen and hypotension. Elevated hepatobiliary enzymes and a thickened and distended gallbladder without gallstones on ultrasonography suggested AAC, but there were no signs of anemia nor thrombocytopenia. Serological screening revealed anti-HAV IgM antibodies. Steroid treatment did not alleviate her symptoms, and she was referred for laparoscopic cholecystectomy. The resected gallbladder was hydropic without perforation, and her clinical signs gradually improved after surgery.
CONCLUSION
AAC can be caused by HAV in AOSD patients. It is crucial to search for the underlying etiology for AAC, especially uncommon viral causes.
Core Tip: Acute acalculous cholecystitis (AAC) can be caused by hepatitis A virus (HAV) infection or adult-onset Still’s disease (AOSD). Cholestasis is more likely to occur in HAV-associated AAC, whereas hematological complications are more common in AOSD-associated AAC. When AAC cannot be explained by AOSD, it is necessary to find other causes of AAC. An acute abdomen caused by HAV-related AAC requires careful consideration of the surgical necessity, since most cases are self-limiting and gallbladder perforation is rare.
