Acute acalculous cholecystitis and dengue fever: a case report from Australia

Introduction and importance: Acute acalculous cholecystitis (AAC) can be a life-threatening condition, particularly in critically ill patients. The pathophysiology appears to be secondary to cholestasis, hypoperfusion, or ischemia. Dengue fever is a rare cause of AAC. Presentation of case: We present the case of a 44-year-old female with non-specific symptoms including right upper quadrant abdominal pain, fatigue, anorexia, vomiting, and fevers. Her clinical examination was consistent with tenderness in the right upper quadrant, with a positive Murphy's sign. Given her deranged biochemical markers, liver function tests, and a consistent sonographic study to support acute cholecystitis, she was booked and consented for an emergency laparoscopic cholecystectomy. Preoperative imaging could not identify any obvious gallstones, and intraoperatively, there were no gallstones appreciated macroscopically. In her postoperative course, the team was notified in retrospect that she had tested positive for dengue fever. Clinical discussion: Dengue fever is a rare cause for AAC and is rare in Australia. The proposed mechanism for its pathophysiology is critical illness including direct invasion of the gallbladder epithelial cells, vasculitis, stasis of biliary flow, and ischemia. Case reports in the literature support conservative treatment of the viral illness and resolution of the inflammation; however, surgical intervention may be required for patients with diffuse peritonitis. Conclusion: Clinicians should consider a wide range of causes for AAC. The challenging nature of this case was to consider a rare cause for AAC in a region not endemic to dengue fever.