open access

Vol 67, No 1 (2016)
Case report
Published online: 2016-03-30
Submitted: 2016-03-07
Accepted: 2016-03-18
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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
·
International Maritime Health 2016;67(1):38-41.

open access

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

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.

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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

DOI

10.5603/IMH.2016.0008

Pubmed

27029928

Bibliographic record

International Maritime Health 2016;67(1):38-41.

Keywords

acalculous cholecystitis
dengue

Authors

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

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