O Measles-Associated Acute Acalculous Cholecystitis

Caroline Clerckx, Jean-Cyr Yombi, Leila Belkhir, Bernard Vandercam

Divisions of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Divisions of Tropical and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

DOI: 10.4236/aid.2012.24016                

Abstract

Background Measles is a highly contagious viral infection whose complications most commonly involve the respiratory tract and the central nervous system. We report here what we think to be the first case of acute acalculous cholecystitis occurring during the course of measles. Case Presentation A 22-year-old female presented with fever, sore throat, coryza and an erythematous maculopapular eruption. The diagnosis of measles was confirmed by the presence of IgM antibodies to measles virus in the absence of IgG antibodies. After initial favorable evolution, she developed abdominal pain with positive Murphy’s sign and elevated liver enzymes. Ultrasonographic examination of the abdomen showed thickening (6.5 mm) of the gallbladder wall in the absence of stones or biliary tract dilatation. Evolution was spontaneously favorable, so that neither antibiotic therapy nor surgical intervention were necessary. Conclusion In the context of worldwide recent measles outbreak, we think that clinicians should be aware of the possible occurrence of acute acalculous cholecystitis, a pathology usually associated with a high rate of complications.

Keywords

Acalculous Cholecystitis; Measles

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. Sabella, “Measles: Not Just a Childhood Rash,” Cleveland Clinic Journal of Medicine, Vol. 77, No. 3, 2010, pp. 207-213. doi:10.3949/ccjm.77a.09123
[2]	F. C. Robbins, “Measles: Clinical Features,” American Journal of Diseases of Children, Vol. 103, 1962, pp. 266-273.
[3]	A. A. Gershon, “Measles Virus (Rubeola) ,” In: G. L. Mandell, J. E. Bennett and R. Dolin, Eds., Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 7th Edition, Expert Consult Premium Edition, Netherlands, 2010, pp. 2229-2236.
[4]	H. Shalev-Zimels, Z. Weizman, C. Lotan, D. Gavish, Z. Ackerman and A. Morag, “The Extent of Measles Hepatitis in Various Ages,” Hepatology, Vol. 8, No. 5, 1988, pp. 1138-1139. doi:10.1002/hep.1840080529
[5]	R. Khatib, M. Siddique and M. Abbass, “Measles Associated Hepatobiliary Disease: An Overview,” Infection, Vol. 21, No. 2, 1993, pp. 112-114. doi:10.1007/BF01710744
[6]	D. Gavish, Y. Kleinman, A. Morag and T. Chajek-Shaul, “Hepatitis and Jaundice Associated with Measles in Young Adults: An Analysis of 65 Cases,” Archives of Internal Medicine, Vol. 143, No. 4, 1983, pp. 674-677. doi:10.1001/archinte.1983.00350040064008
[7]	J. L. Huffman and S. Schenker, “Acute Acalculous Cholecystitis: A Review,” Clinical Gastroenterology and Hepatology, Vol. 8, No. 1, 2010, pp. 15-22. doi:10.1016/j.cgh.2009.08.034
[8]	P. S. Barie and S. R. Eachempati, “Acute Acalculous Cholecystitis,” Current Gastroenterology Reports, Vol. 5, No. 4, 2003, pp. 302-309. doi:10.1007/s11894-003-0067-x
[9]	K. Julka and C. W. Ko, “Infectious Diseases and the Gallbladder,” Infectious Disease Clinics of North America, Vol. 24, No. 4, 2010, pp. 885-898.
[10]	T. Hakala, P. J. Nuutinen, E. T. Ruokonen and E. Alhava, “Microangiopathy in Acute Acalculous Cholecystitis,” British Journal of Surgery, Vol. 84, No. 9, 1997, pp. 1249-1252. doi:10.1002/bjs.1800840915
[11]	J. C. Yombi, C. M. Meuris, A. M. van Gompel, M. Ben Younes and B. C. Vandercam, “Acalculous Cholecystitis in a Patient with Plasmodium Falciparum Infection: A Case Report and Literature Review,” Journal of Travel Medicine, Vol. 13, No. 3, 2006, pp. 178-180. doi:10.1111/j.1708-8305.2006.00023.x
[12]	M. Gora-Gebka, A. Liberek, W. Bako, A. Szarszewski, B. Kaminska and M. Korzon, “Acute Acalculous Cholecystitis of Viral Etiology—A Rare Condition in Children,” Journal of Pediatric Surgery, Vol. 43, No. 1, 2008, pp. 25-27. doi:10.1016/j.jpedsurg.2007.10.073
[13]	S. O. Arya, A. Saini, M. El-Baba, H. Salimnia and N. Abdel-Haq, “Epstein Barr Virus-Associated Acute Acalculous Cholecystitis: A Rare Occurrence but Favorable Out-come,” Clinical Pediatrics, Vol. 49, No. 8, 2010, pp. 799-804. doi:10.1177/0009922810363729
[14]	S. Mourani, S. T. Dobbs, R. M. Genta, A. K. Tandon and B. Yoffe, “Hepatitis A Virus-Associated Cholecystitis,” Annals of Internal Medicine, Vol. 120, No. 5, 1994, pp. 398-400.
[15]	H. R. Brown, N. L. Goller, R. D. Rudelli, J. Dymecki and H. M. Wisniewski, “Postmortem Detection of Measles Virus in Non-Neural Tissues in Subacute Sclerosing Panencephalitis,” Annals of Neurology, Vol. 26, No. 2, 1989, pp. 263-268. doi:10.1002/ana.410260213
[16]	T. R. Moench, D. E. Griffin, C. R. Obriecht, A. J. Vaisberg and R. T. Johnson, “Acute Measles in Patients with and without Neurological Involvement: Distribution of Measles Virus Antigen and RNA,” Journal of Infectious Diseases, Vol. 158, No. 2, 1988, pp. 433-442. doi:10.1093/infdis/158.2.433
[17]	D. E. Griffin, B. J. Ward and L. M. Esolen, “Pathogenesis of Measles Virus Infection: A Hypothesis for Altered Immune Responses,” Journal of Infectious Diseases, Vol. 170, No. S1, 1994, pp. S24-S31. doi:10.1093/infdis/170.Supplement_1.S24