Introduction Hepatitis A is an acute infection of the liver by hepatitis A virus (HAV). Infection may be asymptomatic, result in acute hepatitis, and rarely, fulminant hepatitis. We report a case of acalculous cholecystitis due to acute viral hepatitis A, which is a rare complication of viral hepatitis.

Case report A 9 year old boy was admitted to the children’s assessment unit with a 2 day history of abdominal pain, headache and fever and 1 day history of vomiting. His past medical history was unremarkable and he was not on any regular medications. He had returned from a recent travel to India. On examination he had tenderness in the epigastrium and right hypochondrium. Laboratory investigations revealed raised alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyltransferase (GGT) and total serum bilirubin. Serology tests showed positive IgM for hepatitis A and Epstein-Barr Virus (likely a cross-reaction with the HAV IgM antibodies) and IgG for Epstein-Barr Virus and Cytomegalovirus. Abdominal ultrasound revealed a partially distended thick-walled gall bladder with surrounding pericholecystic fluid. Enlarged lymph nodes were noted at the porta hepatis. He was diagnosed as acute acalculous cholecystitis and was treated conservatively with intravenous fluids, antibiotics, fat soluble vitamins and ursodeoxycholic acid. His symptoms resolved within a fortnight and the liver function tests improved. No surgical intervention was required. He was followed up a month later and was asymptomatic with improved liver function tests.

Discussion Hepatitis A virus infection is a common cause of viral hepatitis, its recognised complications are fulminant hepatitis, cholestasis and prolonged and relapsing disease. Acute acalculous cholecystitis is a rare complication of acute viral hepatitis, this may be associated with gangrene and perforation with increased morbidity and mortality. Treatment is conservative, with indications for urgent cholecystectomy being gangrene or perforation of the gallbladder wall. Early diagnosis and medical management may prevent the need for surgery.

Learning Points Acute acalculous cholecystitis is a rare complication of acute viral hepatitis A.Early diagnosis of this complication and conservative management helps in recovery and may avoid surgical interventions.