Hepatits E presenting as acalculous cholecystitis

Abstract

We report a case of a 30-year old female who presented with right upper quadrant pain and jaundice 30 days after consuming uncooked food in Thailand. Ultrasound examination of the hepatobiliary system revealed a distended gallbladder, thickened wall, sludge and a positive Murphy’s sign, suggesting acalculous cholecystitis. Hepatitis E IgM antibodies were positive. She was treated conservatively with N-acetylcysteine, intravenous antibiotics and cholestyramine, pending the hepatitis E IgM result, with a gradual but full recovery. The association of acalculous cholecystitis with Hepatitis E is rarely described in the literature. Hepatitis E infection should be suspected in patients presenting with ultrasonographic changes in the gallbladder, in areas where hepatitis E is endemic or where there is a suggestive history.