DOI: https://dx.doi.org/10.18203/2349-3933.ijam20220127
Published: 2022-01-25

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

Putu Indri Widiani, Nyoman Angga Santosa, I. Made Suma WIrawan

Abstract


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. 


Keywords


Acute acalculous cholecystitis, Active chronic hepatitis C, Hyperbilirubinemia

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References


Rahim S, Alomari M, Khazaaleh S. Acute Reactive Acalculous Cholecystitis Secondary to Duodenal Ulcer Perforation. Cureus. 2019;11(3):e4331.

Huffman JL, Schenker S. Acute acalculous cholecystitis: a review. Clin Gastroenterol Hepatol. 2010;8:15-22.

Unal H, Korkmaz M, Kirbas I, Selcuk H, Yilmaz U. Acute Acalculous Cholecystitis Associated with Acute Hepatitis B Virus Infection. Int J Infect Dis. 2009;13(5):e310-1.

Mohammed RA, Ghadban W, Mohammed O. Acute Acalculous Cholecystitis Induced by Acute Hepatitis B Virus Infection. Hindawi. 2012.

Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: A systematic review of prevalence, genotypes and risk factors. World J Gastroenterol. 2009;15:5647-53.

CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Recommendation Rep. 1998;47.

Li HC, Lo SY. Hepatitis C virus: Virology, diagnosis and treatment. World J Hepatol. 2015;7(10):1377-89.

Nurul A. Kelainan Ezyme pada Penyakit Hati. Buku Ajar Ilmu Penkait Dalam. 6th edition. Jakarta; Interna Publishing. 2014:640-3.

Yun SP, Seo HI. Clinical aspects of bile culture in patients undergoing laparoscopic cholecystectomy. Medicine. 2018;97(26):1-4.

Warren BL. Small vessel occlusion in acute acalculous cholecystitis. Surgery. 1992;111(2):163-8.

Klar A, Branski D, Nadjari M, Akerman MY, Shoseyov D, Hurvitz H. Gallbladder and pancreatic involvement in hepatitis A. Clin Gastroenterol. 1998;27(2):143-5.

Laurila JJ, Ala-Kokko TI, Laurila PA. Histopathology of acute acalculous cholecystitis in critically ill patients. Histopathology. 2005;47(5):485-92.

Bura M, Michalak M, Chojnicki M, Piaskowska AK, Lisewska IM. Viral Hepatitis A in 108 Adult Patients During an Eight-Year Observation in a Single Center in Poland. Adv Clin Exp Med. 2015;24(5):829-36.

Agergaard J, Larsen CS. Acute acalculous cholecystitis in a patient with primary Epstein-Barr virus infection: a case report and literature review. Int J Infect Dis. 2015;35:67-72.

Kon RJ, Hyun K, Ho KK. Clinical features of Acute Acalculous Cholecystitis. J Clin Gastroenterol. 2003;36(2):166-9.

Glenn F. Acute acalculous cholecystitis. Ann Surg. 1979;189(4):458-65.

Glenn F, Becker CG. Acute acalculous cholecystitis. An increasing entity. Ann Surg. 1982;195(2):131-6.

Meier M, Hollulrich K, Perras B. A rare manifestation of cryoglobulinemic vasculitis: acalculous cholecystitis. Clin Gastroenterol Hepatol. 2005;3(10):A26.

Loriot MA, Bronowicki JP, Lagorce D. Permissiveness of human biliary epithelial cells to infection by hepatitis C virus. Hepatology. 1999;29(5):1587-95.

Vespasiani-Gentilucci U, Carotti S, Onetti-Muda A. Toll-like receptor-4 expression by hepatic progenitor cells and biliary epithelial cells in HCV-related chronic liver disease. Mod Pathol. 2012;25(4):576-89.