Hepatitis A virus-associated acute acalculous cholecystitis in an adult-onset Still’s disease patient: A case report and review of the literature

Table 1 Laboratory findings (at time of current admission)

Laboratory test	Laboratory value	Reference range
White blood cell count (WBC)	17.34	3.5-9.5 (× 109/L)
Hemoglobin (Hb)	14.70	11-15 (g/dL)
Platelets (PLT)	292.00	125-350 (× 109/L)
High-sensitivity C-reactive protein (hsCRP)	15.35	< 8.2 (mg/L)
Erythrocyte sedimentation rate (ESR)	7.00	0-20 (mm/h)
Aspartate aminotransferase (AST)	724.00	10-40 (U/L)
Alanine aminotransferase (ALT)	223.00	9-50 (U/L)
Gamma-glutamyl transferase (GGT)	735.00	8-55 (U/L)
Alkaline phosphatase (ALP)	336.00	40-100 (U/L)
Total bilirubin (TBil)	12.20	0.2-1.2 (mg/dL)
Direct bilirubin (DBil)	10.50	0-0.3 (mg/dL)
Creatinine (Cr)	58.00	45-84 (μmol/L)
Lactate	1.90	0.5-1.0 (mmol/L)
Prothrombin time (PT)	15.10	11-13 (s)
Activated partial thromboplastin time (APTT)	40.20	20-25 (s)

Table 2 Acute acalculous cholecystitis associated with hepatitis A virus infection

Ref.	Age/sex	Symptoms	Physical examination	Vital signs	Ultrasound/CT findings	Bilirubin (total/direct, mg/dL) (0.2-1.2/0-0.3)	AST/ALT (U/I) (10-40/9-50)	WBC (109/L) (3.5-9.5)	Hb (g/dL) (11-15)	Platelets (109/L) (125-350)
Mourani et al[9], 1994	68/M	Fever, chills, nausea, vomiting	Icterus, diaphoretic, hypotensive	/	Thickened gallbladder wall, acalculous	4.8/	5629/8670	/	/	/
Ciftci et al[10], 2001	7/M	Fever, fatigue, abdominal pain, mild respiratory distress	Icterus, abdominal distention, right upper quadrant tenderness	T 37.8 °C, HR 100 bpm, BP 100/70 mmHg	Subhepatic fluid, thickened gallbladder wall, acalculous	7.6/4.8	221/1288	8.8	13.9	/
Ozaras et al[11], 2003	28/M	Fatigue, abdominal pain, dark urine, anorexia, pale stool	Icterus, palpable liver with tenderness, murphy’s sign (+)	/	Perihepatic fluid, thickened gallbladder wall, pericholecystic	8.4/3.9	370/1386	3.7	/	199
	20/F	Nausea, vomiting, fatigue, pruritus, and anorexia	Icterus, right abdominal tenderness, enlarged liver and spleen	/	Hepatosplenomegaly, hydropic gallbladder, acalculous	6.58/2.90	400/815	5.9	/	287
Basar et al[12], 2005	19/F	Fever, right upper abdominal pain	Icterus, right upper quadrant tenderness Murphy’s sign (+)	/	Hepatomegaly, thickened gallbladder wall, acalculous, pericholecystic, intraabdominal fluid	11.6/5.7	984/1213	4.1	/	215
Bouyahia et al[13], 2008	14/M	Fever, vomiting, abdominal pain, myalgia	Right hypochondrium tenderness, enlarged liver and spleen	/	Thickened gallbladder wall, acalculous, pericholecystic fluid collection	4.97/3.33	1327/1112	5.2	13	130
Arroud et al[14], 2009	11/M	Fever, fatigue, vomiting, abdominal pain. myalgia, dark urine, pale stool	Icterus, enlarged liver and spleen	T 38.8 °C	Thickened gallbladder wall, acalculous, pericholecystic fluid collection	4.8/2.7	2953/1918	6.3	11.4	/
Suresh et al[15], 2009	2.5/F	Fever, fatigue nausea, vomiting, abdominal pain, loss of appetite, dark urine, pale stool	Icterus, tenderness in right side abdomen, Murphy’s sign (+), enlarged liver and spleen	T 38.5 °C, HR 86 bpm, RR 22, BP 100/70 mmHg	Hepatosplenomegaly, thickened gallbladder wall, acalculous, pericholecystic fluid	2.8/0.9	20.6/23.4	6.1	13.6	186
Souza et al[6], 2009	16/M	Fever, fatigue, nausea, vomiting, abdominal pain, cephalalgia	Diffuse abdominal pain to superficial and deep palpation	/	Hepatomegaly, thickened gallbladder wall, acalculous	5.01/3.69	1265/1046	/	14.2	112
Al-Amir et al[16], 2015	13/F	Fever, fatigue, vomiting, abdominal pain, dark urine, pale stool	Icterus, epigastric and right upper quadrant tenderness, Murphy’s sign (+)	T 38.8 °C, other vital signs were normal	Thickened gallbladder wall, acalculous, pericholecystic fluid collection	16.1/12.3	3242/4298	4.5	15.4	/
Herek et al[5], 2011	9/M	Fever, nausea, vomiting, abdominal pain	Icterus, tenderness in the right upper quadrant, enlarged liver	T 37.9 °C, HR 84 bpm, BP 100/55 mmHg	Thickened gallbladder wall, acalculous, pericholecystic-free fluid	4.3/3.0	2261/2586	8.1	/	254
Prashanth et al[17], 2012	12/F	Abdominal pain and vomiting	Icterus, tenderness in the right hypochondrium	T 36.9 °C, HR 102 bpm, RR 18, BP 110/80 mmHg	Thickened gallbladder wall, acalculous	3.5/1.05	2150/2580	9	10	180
Kaya et al[18], 2013	31/F	Fever, nausea, abdominal pain, loss of appetite, back and joint pain, darkening of urine	Icterus, tenderness in the right side of the abdomen, Murphy’s sign (+), enlarged liver	37.5 °C, HR 92 bpm, BP 110/60 mmHg	Hepatosplenomegaly, thickened gallbladder wall, acalculous, ascites	2.11/1.92	559/618	3.3	9.5	139
Aldaghi et al[19], 2015	5/M	Fever, abdominal pain	Icterus, mass in the right upper quadrant with tenderness	38 °C, HR 100 bpm, RR 30, BP 100/60 mmHg	Distended gallbladder, normal thickness, acalculous	5.3/3.9	516/722	8	/	426

HAV: Hepatitis A virus; AST: Aspartate transaminase; ALT: Alanine aminotransferase; BP: Blood pressure; RR: Respiratory rate; T: Temperature; WBC: White blood cell count; Hb: Hemoglobin; HR: Heart rate.

Table 3 Acute acalculous cholecystitis associated with adult-onset Still’s disease

Ref.	Age/Sex	Symptoms	Physical examination	Vital signs	Ultrasound/CT findings	Bilirubin (total/direct, mg/dL) (0.2-1.2/0-0.3)	AST/ALT (U/I) (10-40/9-50)	WBC (109/L) (3.5-9.5)	Hb (g/dL) (11-15)	Platelets (109/L) (125-350)
Park et al[20], 2004	49/F	Recurrent fever, rash, and polyarthritis. Confused mental status on admission	Icterus, Murphy’s sign (+), enlarged liver and spleen, facial rash, dehydrated tongue, equivocal neck stiffness, purpuras over the limbs, scabs of zoster	T 39 °C, BP 90/60 mmHg, HR 100 bpm, RR 30	Hepatosplenomegaly, thickened gallbladder wall, pericholecystic fluid collection, ileocolitis, right pleural effusion and ascites	3.7/2.8	453/154	7.1	9.5	17
Vallianou et al[21], 2014	28/F	Fever, vomiting, confused mental status, abdominal pain	Severe and diffuse abdominal tenderness	T 40 °C, no peripheral pulse, systolic BP 50 mmHg	Gallbladder enlargement with edema	/	/	/	/	/
Arai et al[8], 2021	21/F	Recurrent fever, rash, polyarthritis, nausea, vomiting, right hypochondriac pain	Rash, enlarged liver and spleen, tenderness in both shoulder and knee joints	T 40 °C	Hepatosplenomegaly, gallbladder enlargement and wall thickening, acalculous, cervical lymphadenopathy	2.15/1.56	763/469	2.3	11	79

AOSD: Adult-onset Still’s disease; AST: Aspartate transaminase; ALT: Alanine aminotransferase; BP: Blood pressure; RR: Respiratory rate; T: Temperature; WBC: White blood cell count; Hb: Hemoglobin; HR: Heart rate.