Post COVID 19 acute acalculous cholecystitis raising the possibility of underlying dysregulated immune response, a case report

• Published in: Annals of medicine and surgery Vol. 60; pp. 434 - 437
• Main Authors: Alhassan, Shahda Mohamed, Iqbal, Phool, Fikrey, Lubna, Mohamed Ibrahim, Mohanad Ibrahim, Qamar, Muhammad Sohaib, Chaponda, Masautso, Munir, Waqar
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2020; Elsevier
• Subjects: Acalculous cholecystitis; Case Report; COVID 19; Dysregulated immune response; Novel coronavirus disease 2019; SARS-CoV-2; Novel coronavirus disease 2019; SARS-CoV-2; Acalculous cholecystitis; Dysregulated immune response; COVID 19
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1016/j.amsu.2020.11.031

Novel Coronavirus disease 2019 or COVID-19 has rapidly spread throughout the world and has become an unprecedented pandemic. It has a vast spectrum of clinical presentations and can affect various organs. Rarely, it has been reported to cause acalculous cholecystitis in a non ICU setting patient.
Here we report a rare association of COVID 19 with acalculous cholecystitis in a 40 years old healthy woman. She developed fever, malaise, generalized body weakness, and right hypochondrial pain after fourteen days of COVID 19 infection, raising the possibility of Post COVID dysregulated immune response resulting in acalculous cholecystitis. She was managed conservatively with broad spectrum antibiotics.
Acalculous cholecystitis primarily occurs due to the gall bladder's hypomotility and most commonly seen in critically ill patients such as severe burns, mechanically ventilated patients, and prolonged parenteral nutrition. The management depends upon treating the underlying pathology and, in some severe cases, may need surgical intervention as well. Up to our knowledge, COVID 19, causing acalculous cholecystitis, is a rare association described only in a few critically ill patients but not in young, healthy patients. It can be attributed to the body's dysregulated immunological response against the virus resulting in systemic inflammation.
Currently, there is are no clear guidelines for managing acute cholecystitis in COVID-19 patients. It depends on the patient's clinical state and disease severity. We aim to highlight the importance of early diagnosis and management in such clinical scenarios to avoid fatal complications.
•Association between post COVID 19 and acute acalculus cholecystitis.•The possible mechanisms causing acute acalculus cholecystitis in COVID 19 and post COVID 19.•Post COVID 19 Immune dysregulation phenomena in acute acalculus cholecystitis.•Prompt identification and management of acalculus cholecystits in COVID 19.