Hepatitis A and hepatitis E virus co-infection with right pleural effusion, ascites and acute acalculous cholecystitis. A case report / Coinfección por el virus de la hepatitis A y la hepatitis E con derrame pleural derecho, ascitis y colecistitis acalculosa aguda. Reporte de caso

ABSTRACT Hepatitis A and hepatitis E are the leading causes of acute viral hepatitis in developing countries due to our poor sanitary conditions, both spread by fecal-oral route or through contaminated water and food. Being both self-limiting diseases, they are usually benign but may present with atypical clinical findings. A 32 year-old female with right pleural effusion, ascites and acalculous cholecystitis during the course of HAV and HEV co-infection is reported. Clinical improvement was observed with conservative management. As far as we know, this is the first case described of a patient with these three complications in the background of a hepatitis A virus and hepatitis E virus co-infection.

RESUMEN Hepatits A y hepatitis E son las principales causas de hepatitis viral en países en desarrollo debido a las limitadas condiciones sanitarias. Son condiciones usualmente benignas y autolimitadas, pero pueden presentarse de forma atípica. Se reporta una paciente de 32 años con efusión pleural derecha, colecistitis acalculosa y ascitis en el curso de una co-infección por el virus de Hepatitis A y hepatitis E. Hasta donde tenemos conocimiento, este es el primer caso de una paciente con estas tres complicaciones como resultado de una infección por el virus de hepatitis A y hepatitis E.

Toxocarosis y colecistitis aguda alitiásica: ¿consecuencia o coincidencia? / Toxocarosis and acalculous acute cholecystitis: consequence or coincidence?

La toxocarosis humana es una parasitosis larvaria crónica catalogada dentro de las cinco enfermedades subestimadas más importantes por los CDC. Las larvas pueden diseminarse por vía sistémica y migrar a distintos tejidos (larva migrans visceral) incluyendo el hígado y vesícula biliar. La colecistitis aguda acalculosa (CAA) es una enfermedad rara en niños. El diagnóstico se basa en parámetros clínicos y criterios imagenológicos. Se ha asociado a sepsis, shock, trauma, quemaduras, enfermedades sistémicas graves, anomalías congénitas e infecciones, como también en niños sanos. Presentamos el caso de una toxocarosis infantil con síntomas clínicos y criterios imagenológicos compatibles con una CAA tratado médicamente, y discutir la relación entre ambos cuadros en base a la evidencia publicada.

Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children. We report a pediatric case of toxocarosis, with clinical symptoms and imaging criteria compatible with AAC treated medically, and discuss the relationship between toxocarosis and AAC based on published evidence.

Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation / Colecistite aguda acalculosa no lúpus eritematoso sistêmico: uma manifestação inicial rara

ABSTRACT Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.

RESUMO A colecistite aguda acalculosa é uma manifestação gastrointestinal rara no lúpus eritematoso sistêmico e ainda mais rara como manifestação inicial. Foram descritos apenas dois casos até o momento. Os autores relatam o caso de uma mulher negra de 20 anos, com quadro de colecistite aguda acalculosa revelada pela tomografia computadorizada do abdome. Durante a hospitalização, a paciente foi diagnosticada com lúpus eritematoso sistêmico. Houve remissão completa dos sintomas após tratamento conservador com antibióticos. Iniciou-se tratamento com corticosteroides no ambulatório. Embora a colecistectomia seja o tratamento de escolha em casos de colecistite aguda acalculosa como complicação do lúpus eritematoso sistêmico, a paciente respondeu bem ao tratamento conservador; logo, a cirurgia não foi necessária. Este caso é único em razão do modo como o corticosteroide foi iniciado no atendimento ambulatorial. É importante lembrar que a colecistite aguda acalculosa pode ser a manifestação inicial do lúpus eritematoso sistêmico, embora sua ocorrência seja rara. Deve-se considerar a realização de tratamento conservador. A tomografia computadorizada do abdome foi determinante para que fosse feita uma melhor avaliação dacolecistite aguda acalculosa.

Colecistite acalculosa complicada em pacientews com endomiocardiofibrose / Acalculous cholecystitis in a patient complicated by endomyocardial fibrosis

Relata-se o caso de paciente jovem, do sexo feminino, com quadro clínico de colecistite acalculosa e concomitante endomiocardiofibrose biventricular até então não diagnosticada. A relação entre as duas doenças é discutida, questionando a possibilidade da eosinofilia e da insuficiência cardíaca como fatores etiopatogênicos ou agravantes a ambas as entidades. A paciente evoluiu com morte de causa indeterminada.

Early laparoscopic cholecystectomy for acute calculous cholecystitis: what is the optimal timing?

To assess the outcome of optimal timing of early laparoscopic cholecystectomy in cases of acute calculous cholecystitis. Descriptive case series. Shaukat Omer Memorial [Fauji Foundation] Hospital and Hill-Park General Hospital Karachi, from April 2010 to November 2011. Clinical records of 164 patients who underwent early laparoscopic cholecystectomy in acute calculous cholecystitis were retrieved and categorized into two groups according to the timing of surgery from the onset of symptoms [A, who had laparoscopic cholecystectomy within 72 hours; B, who had laparoscopic cholecystectomy after 72 hours]. Outcome of interests were conversion to open procedure, postoperative complications and length of hospital stay. The SPSS version 11 was utilized for data analyses. Chi-square test was used to assess qualitative and unpaired Student t test was employed for quantitative data. A value of p < 0.05 was considered statistically significant. The mean [+SD] age was 40.42 +12.42 year. There were 21 [12.8%] males and 143 [87.2%] females with male to female ratio being 1:6.8. Comparing the two groups, the conversion rates [2.9% versus 13.6%, p=0.012], postoperative complications [1.9% versus 10.2%, p=0.026], and length of hospital stay [2.34 versus 3.93 days, p<0.001] were significantly reduced in group A. The early laparoscopic cholecystectomy within 72 hours minimizes the conversion rates and postoperative complications, and shortens the length of hospital stay in cases of acute calculous cholecystitis

Colecistite alitiásica por dengue: relato de casos / Acalculous cholecystitis in dengue: case reports

JUSTIFICATIVA E OBJETIVOS: Destacar a importância de investigar a colecistite alitiásica em pacientes com dengue, que tenham dor abdominal como sinal de alerta, através da exposição de dois casos diagnosticados no Cento de Referência da Dengue (CRD) no município de Campos dos Goytacazes no primeiro semestre de 2007. RELATO DOS CASOS: Dois pacientes encaminhados ao CRD com quadro clínico de dengue foram submetidos à anamnese, exame físico, rotina laboratorial na admissão e em decorrência de importante queixa álgica abdominal, foi realizada ultrassonografia dessa região. As ultrassonografias, em ambos os casos, evidenciaram vesícula biliar distendida com paredes difusamente espessadas, sem evidências ou sinais de litíase em seu interior (colecistite alitiásica). A pesquisa IgM para dengue foi realizada no 8º dia após o inicio do quadro e confirmou a suspeita clínica inicial. CONCLUSÃO: A colecistite alitiásica é uma manifestação atípica da dengue, normalmente autolimitada, que deve ser pesquisada em todos os pacientes que tenham dor abdominal (como sinal de alerta) e a conduta adequada restringese ao tratamento de suporte, devendo a cirurgia ser reservada às complicações.

BACKGROUND AND OBJECTIVES: Attests the importance of the acalculous cholecystitis investigation in dengue fever patients who present abdominal pain as an alert sign. The article is based on two case reports diagnosed at the Dengue Reference Center (DRC) in the municipality of Campos do Goytacazes in the first half severing of 2007. CASE REPORT: Two patients sent to DRC suspected of having dengue fever were evaluated for a medical history, and subjected to physical examination and routine laboratory tests on admission and were given abdominal ultrasound when they presented with abdominal pain. The ultrasound findings were that the gallbladder wall was diffusely thickened with no evidence or signs of litiase in its interior (acalculous cholecystitis). The serological IgM proved that it was dengue fever on the eighth day after the first symptom. CONCLUSION: The acalculous cholecystitis is an atypical manifestation of dengue fever. It is usually auto-limited, and has to be researched in all patients with abdominal pain as an alert sign. The appropriate conduct is support treatment, and surgical treatment may be reserved only for complications.

Acute acalculous perforated cholecystitis

A case of acute acalculous perforated cholecystitis with acute generalized peritonitis in a middle aged cachectic man, presenting late in a moribund condition, is reported. He underwent emergency laparotomy [subtotal cholecystectomy], went into multi-organ failure and was managed accordingly. The patient recovered in about 2 weeks and was followed-up regularly

Dengue fever presenting as acute acalculus cholecystitis.

Classically dengue fever presents as fever with myalgia. A patient of dengue fever presented with classical symptoms and signs of acute acalculous cholecystitis. Serology and ultrasound examination identified dengue as the aetiology. Patient was treated successfully by conservative measures.

Acute acalculous cholecystitis in an immunocompetent patient with severe acquired toxoplasmosis

Acute acalculous cholecystitis (AAC) is an inflammatory disease of the gallbladder not associated with gallstones. It is more often seen in hospitalized patients on mechanical ventilation due to life-threatening conditions and superimposed sepsis. Occasionally, infection itself may be the only predisposing factor identified. AAC has rarely been observed in severely immunocompromised patients with reactivated Toxoplasma infection. We were able to document for the first time a case of AAC in an otherwise healthy adult with acute acquired toxoplasmosis. A prompt diagnosis and early onset of effective antiparasitic treatment allowed the resolution of the episode without further complication