Gallbladder Wall Thickening in an Adolescent With Acute Mononucleosis: A Case Report and Brief Review of the Literature

Epstein-Barr Virus Masking Acalculous Cholecystitis in a 19-Year-Old Male

Epstein-Barr virus (EBV), a member of the Herpesviridae family, is widely distributed and highly prevalent worldwide. It is known to cause infectious mononucleosis, characterized by symptoms such as fever, pharyngitis, lymphadenopathy, and atypical lymphocytosis in adults. In the pediatric population, acute EBV infection is typically asymptomatic.  Acute cholecystitis, on the other hand, refers to acute inflammation within the gallbladder, typically due to the obstruction of the cystic duct secondary to gallstones. Patients will often present with right upper quadrant pain positive for Murphy sign, among other manifestations such as fever, fatigue, and jaundice. EBV and acute cholecystitis rarely coincide with one another. This abstract presents a comprehensive analysis of a clinical case that illustrates how an EBV infection obscured the clinical presentation of acute cholecystitis. This case underscores the necessity for a nuanced approach to the diagnosis, especially when the standard of care diagnostic criteria become inconclusive. However, hepatocellular injury as a result of EBV infection is rare. In this case report, we present the case of a 19-year-old male who developed EBV-induced hepatitis, emphasizing the importance of considering EBV as a potential cause in similar clinical scenarios.

Epstein-Barr Virus (EBV) acute acalculous cholecystitis in an immunocompromised adult patient: a case report and a literature review of a neglected clinical presentation

Primary Epstein-Barr virus (EBV) infection may present with self-limiting abdominal involvement, characterized by hepatitis with mild elevation of aminotransferases, splenomegaly, and rarely with acute acalculous cholecystitis (AAC). Usually, treatment of EBV related AAC is symptomatic, without the need for surgery. Here, we describe a severe case of AAC occurring as the first manifestation of infectious mononucleosis in a young adult woman, receiving treatment with interleukin 6 receptor (IL-6r) inhibitor for rheumatoid arthritis (RA); moreover, we have performed a review of the literature on EBV-related AAC.

Gallbladder wall thickening on bedside ultrasound in a child with Epstein-Barr virus infection

Gallbladder wall thickening (GBWT) is rarely reported in children with acute Epstein-Barr virus (EBV) infection. We present a child with EBV infection who was found on point-of-care ultrasound to have GBWT without signs of cholecystitis that subsequently resolved without intervention. We expect the proliferation of mobile and handheld sonography to increase the number of bedside examinations in febrile children. This, in turn, will increase the incidence of GBWT found in patients with EBV infection and without right upper quadrant pain. Prospective study is needed to define the incidence of GBWT in children with EBV infection.

Pancreatitis and cholecystitis in primary acute symptomatic Epstein-Barr virus infection - Systematic review of the literature

Acute pancreatitis and acalculous cholecystitis have been occasionally reported in primary acute symptomatic Epstein-Barr virus infection. We completed a review of the literature and retained 48 scientific reports published between 1966 and 2016 for the final analysis. Acute pancreatitis was recognized in 14 and acalculous cholecystitis in 37 patients with primary acute symptomatic Epstein-Barr virus infection. In all patients, the features of acute pancreatitis or acalculous cholecystitis concurrently developed with those of primary acute symptomatic Epstein-Barr virus infection. Acute pancreatitis and acalculous cholecystitis resolved following a hospital stay of 25days or less. Acalculous cholecystitis was associated with Gilbert-Meulengracht syndrome in two cases. In conclusion, this thorough analysis indicates that acute pancreatitis and acalculous cholecystitis are unusual but plausible complications of primary acute symptomatic Epstein-Barr virus infection. Pancreatitis and cholecystitis deserve consideration in cases with severe abdominal pain. These complications are usually rather mild and resolve spontaneously without sequelae.