A rare case report of acute acalculous cholecystitis in active chronic hepatitis C virus infection

Acute acalculous cholecystitis (AAC) is an inflammation of gallbladder with absence of gall stones or bile sludge. Daily cases reported about 90-95% of the acute cholecystitis present with gall stone, while only 5-15% occur without gall stones obstruction.AAC is reported associated with Epstein bar virus infection, hepatitis B virus and hepatitis A virus. Hepatitis C-induced AAC cases still rare. This case report presents a 49-years-old female patient with epigastric pain, nausea, yellowish sclera, tea urine color, pale stool and there was a history of the patient's husband with hepatitis C. On physical examination there was epigastric and right hypochondriac pain, and positive murphy sign. There was leukocytosis, hyperbilirubinemia and an increase in SGPT (1.360 U/L) and SGOT (1.720 U/L). Antibodies to HCV were positive. Abdominal ultrasonography showed cholecystitis with no biliary duct dilatation and no parenchymal liver disease appearance The patient was diagnosed with acute chronic hepatitis C and cholecystitis. Pathophysiology of hepatitis C induced AAC is not fully understood, but is thought to be due to complexes immune, directly infect gallbladder and proximal biliary epithelial cells uncontrolled, increased portal/septal myofibroblasts activity and inflammation. The presence of AAC with an increase in serum levels of SGOT and SGPT 5-10 times the normal limit should be suspected due to acute hepatitis viral infection. Further research still needs to be done to determine the relationship between hepatitis C and the incidence of AAC.

Hepatitis B-cuadro clínico / Hepatitis B-clinical history

Las manifestaciones clínicas de la hepatitis viral tipo B tienen un amplio abanico de presentaciones, dependiendo de muchos factores, algunos desconocidos y otros, perfectamente identificables: subtipo del virus, características genéticas del huésped, estado inmunológico en el momento de la inoculación, carga viral y vía de entrada de dicha inoculación, entre los más importantes. La clínica de la hepatitis viral por virus B tanto aguda como crónica puede ser desde síntomas inespecíficos sin ictericia, a un cuadro severo con ictericia y encefalopatía. La hepatitis B que se manifiesta por primera vez, se clasifica como hepatitis aguda y hepatitis fulminante. La hepatitis B no aguda se clasifica en hepatitis subaguda o prolongada, hepatitis crónica persistente y hepatitis crónica activa.

The clinical manifestations of hepatitis B has a wide spectrum of presentations that depend on many factors, some are unknown and others very well identifiable: virus subtypes, genetic characteristics of the host, immunological status at the time of inoculation, viral burden, and entrance pathway of such inoculation, among others. The clinical case of acute and chronic hepatitis type B, can show either unspecific symptoms without jaundice or a severe case of jaundice and encephalopathy. The hepatitis B that manifests for the first time is classified as acute hepatitis and fulminant.