Acute Acalculous Cholecystitis caused by the Epstein-Barr Virus in a Young Woman

Background: The Epstein-Barr Virus (EBV) is a common virus that causes infectious mononucleosis, which typically includes symptoms such as fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, and elevated liver enzymes. However, acalculous cholecystitis has been reported as a rare complication of EBV. Acute acalculous cholecystitis only accounts for 10% of all acute cholecystitis cases. Case information: Here, we report a case of acalculous cholecystitis caused by EBV, which was treated successfully by medical treatment without surgery. An 18-year-old woman presented to the office for a four-day history of abdominal pain, nausea, vomiting, and dark urine. Physical exam showed scleral icterus and tenderness in the epigastric and right upper quadrant abdominal regions. Lab results indicated elevated LFTs, alkaline phosphatase, reactive lymphocytes, and hyperbilirubinemia. An ultrasound showed gallbladder wall thickening with no gallstones. Next, she was admitted and underwent an abdominopelvic CT, MRCP, viral hepatitis serology testing, and gastroenterology consultation. CT and MRCP showed hepatomegaly, splenomegaly, and gallbladder wall edema. Serology showed a positive EBV IgM. At this point, we diagnosed her with an acute EBV infection, causing acute acalculous cholecystitis. Subsequently, she improved with supportive care and was discharged home. Conclusion: Though acalculous cholecystitis rarely accompanies EBV, clinicians should be aware of this complication to avoid an unnecessary cholecystectomy.