Pediatr Gastroenterol Hepatol Nutr.  2012 Mar;15(1):57-61.

A Case of Epstein-Barr Virus Infection with Gall Bladder and Common Bile Duct Stones in an Otherwise Healthy Child

• Park JH
• Noh JC
• Park HM
• Jung YS
• Park SH
• Hong HC
• Shin HJ

Abstract

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis.

Keyword

Epstein-Barr virus; Cholelithiasis; Choledocholithiasis

MeSH Terms

Anti-Bacterial Agents
Child
Cholecystectomy, Laparoscopic
Cholecystitis
Choledocholithiasis
Cholelithiasis
Common Bile Duct
Epstein-Barr Virus Infections
Herpesvirus 4, Human
Humans
Urinary Bladder
Urinary Bladder Calculi
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Abdominal ultrasonography on the 2nd day of hospitalization revealed (A) an arcuate echogenic density with posterior shadowing in the GB neck and (B) proximal dilation of the CBD (maximum about 1 cm) with stone.

• 

  Fig. 2 Abdominal CT revealed dilation of the IHD and CBD but no delineating stone anywhere.

• 

  Fig. 3 Abdominal ultrasonography on the 4th day of hospitalization showed (A) more dilated CBD with more descended stone, (B) a persistent stone in the GB neck.

• 

  Fig. 4 ERCP revealed moderate CBD dilatation but a normalized IHD size as compared to previous CT scans. The balloon cholangiography did not reveal any stones in the region.

• 

  Fig. 5 Diisopropyl iminodiacetic acid (DISIDA) scan showed that liver, CBD, and small bowel uptake were normal, but GB was invisible.

Reference

1. Macsween KF, Crawford DH. Epstein-Barr virus-recent advances. Lancet Infect Dis. 2003. 3:131–140.

2. Hinedi TB, Koff RS. Cholestatic hepatitis induced by epstein-barr virus infection in an adult. Dig Dis Sci. 2003. 48:539–541.

3. Yang HN, Hong KW, Lee JS, Eom JS. A case of acute cholecystitis without cholestasis caused by Epstein-Barr virus in a healthy young woman. Int J Infect Dis. 2010. 14:E448–E449.

4. Palasciano G, Portincasa P, Vinciguerra V, Velardi A, Tardi S, Baldassarre G, et al. Gallstone prevalence and gallbladder volume in children and adolescents (An epidemiological ultrasonographic survey and relationship to body mass index). Am J Gastroenterol. 1989. 84:1378–1382.

5. Wesdorp I, Bosman D, de Graaff A, Aronson D, van der Blij F, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr. 2000. 31:411–417.

6. Poddar U. Gallstone disease in children. Indian Pediatr. 2010. 47:945–953.

7. Sirmatel O, Sirmatel F, Eris FN, Karsligil T. The cases of cholestatic hepatitis in the course of atypical epstein-barr virus infection. Research J Med Sci. 2010. 4:136–141.

8. Prassouli A, Panagiotou J, Vakaki M, Giannatou I, Atilakos A, Garoufi A, et al. Acute acalculous cholecystitis as the initial presentation of primary Epstein-Barr virus infection. J Pediatr Surg. 2007. 42:E11–E13.

9. Lagona E, Sharifi F, Voutsioti A, Mavri A, Markouri M, Attilakos A. Epstein-Barr virus infectious mononucleosis associated with acute acalculous cholecystitis. Infection. 2007. 35:118–119.

10. Koch AD, van den Bosch HC, Bravenboer B. Epstein-Barr virus associated cholecystitis. Ann Intern Med. 2007. 146:826–827.

11. Iaria C, Arena L, Di Maio G, Fracassi MG, Leonardi MS, Famulari C, et al. Acute acalculous cholecystitis during the course of primary Epstein-Barr virus infection (a new case and a review of the literature). Int J Infect Dis. 2008. 12:391–395.