Acute acalculous cholecystitis associated with severe EBV hepatitis in an immunocompetent child

Area of Science:

• Pediatric Gastroenterology
• Infectious Diseases
• Hepatology

Background:

• Acute acalculous cholecystitis (AAC) is uncommon in children and typically associated with systemic infections.
• Diagnosis relies on imaging, often within a non-specific clinical context.
• AAC linked to Epstein-Barr virus (EBV) is rarely documented, with gastrointestinal symptoms often being mild.

Observation:

• A case of EBV-related AAC with severe hepatitis in an immunocompetent child is presented.
• The patient exhibited an unusually severe liver impairment.
• Despite the severity, the clinical course was benign.

Findings:

• Medical management focused on supportive care, including analgesia and fluid resuscitation.
• Prompt discontinuation of broad-spectrum antibiotics upon EBV diagnosis was key.
• Successful treatment without surgical intervention was achieved.

Implications:

• This case expands the understanding of EBV's potential gastrointestinal manifestations in children.
• It emphasizes the importance of considering viral etiologies, like EBV, in pediatric AAC.
• Highlights the efficacy of conservative medical management for EBV-associated AAC, even with significant hepatitis.