open access

Vol 67, No 1 (2016)
Case report
Submitted: 2016-03-07
Accepted: 2016-03-18
Published online: 2016-03-30
Get Citation

A case of acalculous cholecystitis in the course of dengue fever in a traveller returned from Brazil

Anna Kuna, Agnieszka Wroczyńska, Michał Gajewski, Iwona Felczak-Korzybska, Wacław L. Nahorski
DOI: 10.5603/IMH.2016.0008
·
Pubmed: 27029928
·
IMH 2016;67(1):38-41.

open access

Vol 67, No 1 (2016)
TROPICAL MEDICINE Case report
Submitted: 2016-03-07
Accepted: 2016-03-18
Published online: 2016-03-30

Abstract

Background: Dengue is the second cause of fever after malaria in travellers returning from the tropics. The infection may be asymptomatic or it may manifest itself with fever only, some patients, however, may develop haemorrhagic symptoms and shock.

Materials and methods: A 58-year-old woman came to the University Centre of Tropical Medicine in Gdynia after returning from a tourist journey to Brazil because of fever up to 39oC and malaise. She had lived in South America many years and then moved to Europe 3 years before hospitalisation. On admission physical examination revealed fever, dry mucosa, moderate hypotension and tachycardia. In the laboratory test results, leukopoenia, thrombocytopoenia and elevated transaminases were observed. On the second day of the hospitalisation, the patient reported epigastric pain, clinical examination revealed tenderness of the abdomen and macular rash on the skin of the trunk and thighs. The ultrasonography revealed an enlarged gallbladder with thickened walls, with hypoechogenic area surrounding it, a dilated common biliary duct of heterogenic echo, and some free fluid in the peritoneal cavity. An exploratory laparotomy was performed after 24 h because of the persisting strong abdominal pain and high fever. Intraoperatively, enlarged mesenteric lymph nodes were found, with no symptoms of gallbladder pathology. The postoperative course was uncomplicated and the positive result of immunochromatographic assay for dengue was obtained.

Results: The acalculous cholecystitis has been described in the course of various diseases and conditions. The typical symptoms include pain in the right hypochondriac region, fever, positive Murphy’s sign, and abnormal liver function tests, which were observed in the presented case. Cholecystectomy is not usually indicated in the course of dengue (typically a self-limiting disease) due to a high risk of bleeding.

Conclusions: The case provides a rationale for the inclusion of acalculous cholecystitis in the differential diagnosis in patients with abdominal pain returning from dengue endemic areas.

Abstract

Background: Dengue is the second cause of fever after malaria in travellers returning from the tropics. The infection may be asymptomatic or it may manifest itself with fever only, some patients, however, may develop haemorrhagic symptoms and shock.

Materials and methods: A 58-year-old woman came to the University Centre of Tropical Medicine in Gdynia after returning from a tourist journey to Brazil because of fever up to 39oC and malaise. She had lived in South America many years and then moved to Europe 3 years before hospitalisation. On admission physical examination revealed fever, dry mucosa, moderate hypotension and tachycardia. In the laboratory test results, leukopoenia, thrombocytopoenia and elevated transaminases were observed. On the second day of the hospitalisation, the patient reported epigastric pain, clinical examination revealed tenderness of the abdomen and macular rash on the skin of the trunk and thighs. The ultrasonography revealed an enlarged gallbladder with thickened walls, with hypoechogenic area surrounding it, a dilated common biliary duct of heterogenic echo, and some free fluid in the peritoneal cavity. An exploratory laparotomy was performed after 24 h because of the persisting strong abdominal pain and high fever. Intraoperatively, enlarged mesenteric lymph nodes were found, with no symptoms of gallbladder pathology. The postoperative course was uncomplicated and the positive result of immunochromatographic assay for dengue was obtained.

Results: The acalculous cholecystitis has been described in the course of various diseases and conditions. The typical symptoms include pain in the right hypochondriac region, fever, positive Murphy’s sign, and abnormal liver function tests, which were observed in the presented case. Cholecystectomy is not usually indicated in the course of dengue (typically a self-limiting disease) due to a high risk of bleeding.

Conclusions: The case provides a rationale for the inclusion of acalculous cholecystitis in the differential diagnosis in patients with abdominal pain returning from dengue endemic areas.

Get Citation

Keywords

acalculous cholecystitis, dengue

About this article
Title

A case of acalculous cholecystitis in the course of dengue fever in a traveller returned from Brazil

Journal

International Maritime Health

Issue

Vol 67, No 1 (2016)

Article type

Case report

Pages

38-41

Published online

2016-03-30

Page views

1679

Article views/downloads

2032

DOI

10.5603/IMH.2016.0008

Pubmed

27029928

Bibliographic record

IMH 2016;67(1):38-41.

Keywords

acalculous cholecystitis
dengue

Authors

Anna Kuna
Agnieszka Wroczyńska
Michał Gajewski
Iwona Felczak-Korzybska
Wacław L. Nahorski

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl