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Case Reports
. 2022 Aug 19:81:104437.
doi: 10.1016/j.amsu.2022.104437. eCollection 2022 Sep.

Acute acalculous cholecystitis in a pediatric dengue hemorrhagic fever patient: A case report, lesson learned from limited resource setting

Amallia Nuggetsiana Setyawati  1   2   3 , Kusmiyati Tjahjono Dk  1 , Melissa Angela Chionardes  1 , Nahwa Arkhaesi  2
Affiliations
Case Reports

Acute acalculous cholecystitis in a pediatric dengue hemorrhagic fever patient: A case report, lesson learned from limited resource setting

Amallia Nuggetsiana Setyawati et al. Ann Med Surg (Lond). .

Abstract

Introduction: Dengue fever (DF) is endemic in numerous regions of Indonesia with primary clinical features such as high fever as well as pullout of intravascular fluid and albumin leakage, which provokes pleural effusion, hypoproteinemia, and blood hemoconcentration. However, the incidence of abdominal pain as a clinical manifestation of DF, which refers to acalculous cholecystitis, is rare.

Case presentation: An 11-year-old female was admitted to the to hospital with fever, headache, and myalgia. Blood examination resulted in low platelet coua nt and positive IgM Dengue antibody test. On the third day, the patient felt sharp abdominal pain. Abdominal ultrasound showed cholecystitis, cholestasis, pleural effusion, ascites, and laboratory finding showed increased C-reactive protein. The management was conservative and discharged at the 7th day.

Discussion: The acalculous cholecystitis in Dengue Fever/Dengue Hemorrhagic fever (DF/DHF) is challenging in diagnose due to atypical presentations. Several proposed mechanisms are critical illness, including direct invasion of the gallbladder epithelial cells, vasculitis, stasis of biliary flow, obstruction of the biliary tree, ischemia, and sequestration. The actual mechanism of the dengue virus has been proposed that direct viral incursion of the gallbladder may yield edema and exudation. Abdominal ultrasonography is considered to diagnose acute acalculous cholecystitis (AAC) in children.

Conclusion: Understanding pathophysiology of the acalculous cholecystitis in DF/DHF patients and atypical presentation of sharp abdominal pain help physicians for early diagnosis and management both in monitoring and patient care management. Abdominal ultrasonography can help physicians to diagnose AAC.

Keywords: AAC, Acute acalculous cholecystitis; ALT, Alanine aminotransferase; AST, Aspartate transferase; Abdominal pain; Acalculous cholecystitis; Atypical symptoms; DF, Dengue fever; DHF; DHF, Dengue hemorrhagic fever; DSS, Dengue shock syndrome.

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Conflict of interest statement

No Conflicts of Interest.

Figures

Fig. 1
Fig. 1
Chest Xray on 3rd day showed a remarkable pleura effusion with PEI 38.13%.
Fig. 2
Fig. 2
Abdominal ultrasonography showed acalculous cholecystitis, right cholestasis, ascites on 5th day.
See this image and copyright information in PMC

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