Pediatric Infectious Diseases Unit, Hospital Dona Estefânia. CHLC-EPE Lisboa. Portugal
- Reunião internacional: ESPID 2021
Resumo:
Background Hepatitis A is a common disease in childhood, usually presented as a benign viral infection. Recognized complications of hepatitis A include cholestasis, prolonged and relapsing disease, fulminant hepatitis, and triggering of chronic active autoimmune extrahepatic disease. The authors report three cases of acute acalculous cholecystitis due to hepatitis A, which is a rare complication of common viral hepatitis.
Cases Presentation Summary The authors present three patients (9-years-old female from Guinea-Bissau, 11-years-old and 16-years-old portuguese males), one with history of autosomal dominant polycystic kidney disease and epilepsy. All patients presented with severe abdominal pain at the right hypochondrium and mild jaundice, while two also complained with anorexia, nausea and vomiting and one with low fever. Laboratory investigation revealed normal white blood count and C-reactive protein, and elevated liver transaminases (AST 586-4044 U/L, ALT 716-4108 U/L), GGT (72-293 U/L) and total bilirubin (2.10-5,84 mg/dL). Abdominal ultrasound presented gallbladder wall thickness (5-10 mm) in the absence of calculous or sludge, in all patients. Serological tests revealed acute hepatitis A infection, while other causes were excluded (CMV, EBV, HBV, HCV, HIV, Salmonella spp. and other bacterial infections). Patients were treated conservatively (antibiotic therapy and general measures), with progressive clinical improvement.
Learning Points/Discussion Acute acalculous cholecystitis related to acute hepatitis is a challenging diagnosis, since clinical presentation is unspecific and laboratory findings can be overlapping due to intra-hepatic cholestasis present in hepatitis A. Abdominal ultrasound is key to establish diagnosis, showing wall thickness >3.5 mm. Distinct than in adults, conservative therapy seems to be adequate in the majority of pediatric patients with acalculous cholecystitis.
Palavras Chave: Acute acalculous cholecystitis, Hepatitis A