Gallbladder wall thickening in children with infectious mononucleosis

Epstein-Barr Virus (EBV) acute acalculous cholecystitis in an immunocompromised adult patient: a case report and a literature review of a neglected clinical presentation

Primary Epstein-Barr virus (EBV) infection may present with self-limiting abdominal involvement, characterized by hepatitis with mild elevation of aminotransferases, splenomegaly, and rarely with acute acalculous cholecystitis (AAC). Usually, treatment of EBV related AAC is symptomatic, without the need for surgery. Here, we describe a severe case of AAC occurring as the first manifestation of infectious mononucleosis in a young adult woman, receiving treatment with interleukin 6 receptor (IL-6r) inhibitor for rheumatoid arthritis (RA); moreover, we have performed a review of the literature on EBV-related AAC.

Gallbladder wall thickening in mononucleosis syndromes

PURPOSE

We used sonography to measure gallbladder wall thickness in patients with mononucleosis syndromes and then evaluated laboratory data, spleen size, and clinical evolution to assess any relationship between gallbladder wall thickening (GBWT) and the severity of disease.

METHODS

We retrospectively reviewed the medical records, sonograms, and sonographic reports of 39 patients who were diagnosed with mononucleosis syndromes on the basis of fever, tonsillopharyngitis, cervical adenopathy, hepatosplenomegaly, and lymphocytosis with atypical lymphocytes. All 39 were included in the study. The gallbladder wall thickness in each patient was sonographically determined. GBWT was defined as a wall thickness exceeding 3 mm. We assessed the laboratory data and clinical evolution in each patient, and the differences between patients with and without GBWT were statistically analyzed.

RESULTS

Six patients (15%) had GBWT. The mean atypical lymphocyte count +/- standard deviation (SD) in the patients with GBWT (1,830/microl +/- 1,000/microl) was significantly higher than that in patients without GBWT (1,140/microl +/- 660/microl; p < 0.05). The mean total serum protein and serum albumin levels in the patients with GBWT (6.6 mg/dl +/- 0.7 mg/dl and 3.7 mg/dl +/- 0.5 mg/dl, respectively) were significantly lower than those in patients without GBWT (7.3 mg/dl +/- 0.4 mg/dl and 4.1 mg/dl +/- 0.3 mg/dl, respectively; p < 0.05). The duration of hospitalization in the patients with GBWT (14 +/- 8.5 days) was significantly higher than that in patients without GBWT (8 +/- 3.5 days; p < 0.05).

CONCLUSIONS

GBWT in mononucleosis syndromes may be a sign of the severity of the illness and when present indicates the need to carefully monitor the clinical course.

CT diagnosis of a clinically unsuspected acute appendicitis complicating infectious mononucleosis

Acute appendicitis is a rare complication of infectious mononucleosis (IM). We describe a patient with IM and splenic rupture with a computerized tomography (CT) diagnosis of acute appendicitis during the acute phase of the infectious disease. Diagnostic imaging features of acute appendicitis were found on an abdominal CT performed for the evaluation of postoperative fever. Histologic examination confirmed the CT diagnosis of the clinically unsuspected acute appendicitis. Our case is unique both for the rarity of this complication and the lack of clinical symptoms.

Gallbladder wall thickening in infectious mononucleosis: an ominous sign

Gallbladder wall thickening (3 mm or greater) is a nonspecific finding with many causes. We describe two cases caused by infectious mononucleosis. Other causes of gallbladder wall thickening are described and the literature is reviewed. We suggest that the finding of gallbladder wall thickening in a patient with infectious mononucleosis implies that the patient is very ill, and its observation should lead to close patient monitoring.

Gallstone ileus--beware the silent second stone

Gallstone ileus remains a rare but important cause of small bowel obstruction. We report a case of recurrent gallstone ileus, presumably caused by an unidentified second stone resident within the gallbladder at the time of the initial laparotomy. This raises important questions about the traditional surgical management of this interesting condition.