Epstein-Barr in a Patient Presenting with Right Upper Quadrant Pain: A Case Report from the Emergency Department

Epstein-Barr in a Patient Presenting with Right Upper Quadrant Pain: A Case Report from the Emergency Department

Right upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis. This case...

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Bibliographic Details
Published in:The Journal of emergency medicine Vol. 66; no. 3; pp. e365 - e368
Main Authors: Khan, Umael, Aarebrot, Anders, Mo, Solveig, Landa, Signe, Rösler, Cornelia, Sodha, Ole Kamal, Bjørneklett, Rune, Dizdar, Vernesa
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-03-2024
Subjects:
abdominal pain
Abdominal Pain - etiology
acalculous cholecystitis
Anti-Bacterial Agents - therapeutic use
Cholecystitis - complications
Cholecystitis - diagnosis
Cholestasis
EBV
Emergency Service, Hospital
Epstein-Barr
Epstein-Barr Virus Infections - complications
Epstein-Barr Virus Infections - diagnosis
Female
Gallstones - complications
Herpesvirus 4, Human
Humans
EBV
acalculous cholecystitis
abdominal pain
Epstein-Barr
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Summary:Right upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis. This case report discusses a young woman presenting to the emergency department with acute right upper quadrant abdominal pain. The initial assessment revealed a positive Murphy's sign, elevated white blood count, and a cholestatic pattern on liver function tests, leading one to suspect bacterial calculous cholecystitis and initiating antibiotic therapy. However, clinical examination also revealed tonsillar exudates and differential white blood cell count revealed monocytosis and lymphocytosis rather than a high neutrophil count. The patient tested positive for EBV. Furthermore, ultrasound and magnetic resonance imaging revealed gallbladder wall edema with no gallstones, leading one to conclude that the clinical manifestation and laboratory results were due to an EBV infection. Antibiotic therapy was ceased and the patient did not require surgical intervention. Calculous bacterial cholecystitis usually entails antibiotic therapy and cholecystectomy. It is important to be aware of the differential diagnosis of EBV, as it usually does not require either of these and resolves spontaneously.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
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ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2023.10.005