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Study of acute acalculous cholecystitis as an atypical manifestation in dengue fever

Anurag Prasad, Muzaffari yasmeen, Suchitra Gupta Prasad, Md. Rashid Taj, Gagan Saxena.

Background: Dengue is a rapidly emerging global health problem. It is an arboviral disease caused by four antigenically distinct dengue viruses. Dengue epidemic occurs annually with major outbreaks in various parts of the world. The disease has variable presentation. Atypical manifestations have increased as well, which are missed owing to lack of awareness. Among these, dengue fever (DF) with acute acalculous cholecystitis is also reported. A few case reports have also shown complications due to acute acalculous cholecystitis in dengue.

Objective: To study the incidence and outcome of acute acalculous cholecystitis in patients with DF.

Materials and Methods: This study was a prospective, hospital-based observational study conducted from September 2012 to October 2014. After satisfying the World Health Organization criteria, the diagnosis of DF was confirmed in patients on clinical presentation and by a positive immunoglobulin M antibody test result for a late-phase or convalescent-phase blood specimen. Abdominal ultrasound was performed to confirm the diagnosis of acute acalculous cholecystitis. A statistical analysis of the findings was carried out.

Results: Laboratory examination confirmed the diagnosis of dengue in 120 patients. The most common atypical manifestation was hepatitis (n = 52; 43.33%), followed by acute acalculous cholecystitis (n = 45; 37.5%). Clinical manifestations of acalculous cholecystitis were abdominal pain, vomiting, and dyspepsia. Fever was present in 44 patients (97.77%). Liver function tests were deranged in all the cases. The study had a survival rate of 100%, without any complication.

Conclusion: Acute acalculous cholecystitis in dengue is not a very uncommon finding. Early diagnosis and appropriate treatment have very good prognosis.

Key words: Dengue fever, atypical manifestations, acute acalculous cholecystitis

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