[Acalculous cholecystitis in hantavirus infections]

Three men, aged 32, 56 and 41 years, respectively, were hospitalized within two weeks because of flu-like symptoms, limb pain and abdominal pain. Being in a febrile, impaired general condition, pressure pains in the upper abdomen and flank pains were particularly noteworthy.

The results of the examinations, indicating acute renal insufficiency, thrombocytopenia and elevated lactate dehydrogenase were typical of a hantavirus infection, and positive serology for the puumala virus confirmed this suspicion. Ultrasonography indicated nephritic changes in all cases. Striking and unusual, however, was the finding of an acalculous cholecystitis.

In one of the three cases, antibiotic therapy with ceftriaxone was performed, in the other two cases symptomatic therapy. The cholecystitis was closely monitored sonographically and healed without complications in all cases.

Hantavirus infections are common in an endemic area such as the Swabian Alb in Southern Germany, but an acalculous cholecystitis was rarely described in such a context. This accumulation is very remarkable, and the knowledge about it can both help to detect complications at an early stage and prevent unnecessary cases of cholecystectomy.