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A case of acalculous cholecystitis in the course of dengue fever in a traveller returned from Brazil.
Int Marit Health. 2016; 67(1):38-41.IM

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 39°C 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.

Authors+Show Affiliations

No affiliation info availableNo affiliation info availableDepartment of Infectious Diseases, Medical University of Gdańsk. mgajewski@gumed.edu.pl.No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27029928

Citation

Kuna, Anna, et al. "A Case of Acalculous Cholecystitis in the Course of Dengue Fever in a Traveller Returned From Brazil." International Maritime Health, vol. 67, no. 1, 2016, pp. 38-41.
Kuna A, Wroczyńska A, Gajewski M, et al. A case of acalculous cholecystitis in the course of dengue fever in a traveller returned from Brazil. Int Marit Health. 2016;67(1):38-41.
Kuna, A., Wroczyńska, A., Gajewski, M., Felczak-Korzybska, I., & Nahorski, W. L. (2016). A case of acalculous cholecystitis in the course of dengue fever in a traveller returned from Brazil. International Maritime Health, 67(1), 38-41. https://doi.org/10.5603/IMH.2016.0008
Kuna A, et al. A Case of Acalculous Cholecystitis in the Course of Dengue Fever in a Traveller Returned From Brazil. Int Marit Health. 2016;67(1):38-41. PubMed PMID: 27029928.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case of acalculous cholecystitis in the course of dengue fever in a traveller returned from Brazil. AU - Kuna,Anna, AU - Wroczyńska,Agnieszka, AU - Gajewski,Michał, AU - Felczak-Korzybska,Iwona, AU - Nahorski,Wacław L, PY - 2016/03/07/received PY - 2016/03/18/accepted PY - 2016/03/18/revised PY - 2016/4/1/entrez PY - 2016/4/1/pubmed PY - 2017/1/4/medline KW - acalculous cholecystitis KW - dengue SP - 38 EP - 41 JF - International maritime health JO - Int Marit Health VL - 67 IS - 1 N2 - 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 39°C 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. SN - 2081-3252 UR - https://www.unboundmedicine.com/medline/citation/27029928/A_case_of_acalculous_cholecystitis_in_the_course_of_dengue_fever_in_a_traveller_returned_from_Brazil_ L2 - https://journals.viamedica.pl/international_maritime_health/article/view/44981 DB - PRIME DP - Unbound Medicine ER -