Epstein-Barr in a Patient Presenting with Right Upper Quadrant Pain : A Case Report from the Emergency Department
Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved..
BACKGROUND: Right upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis.
CASE REPORT: This case report discusses a young woman presenting to the emergency department with acute right upper quadrant abdominal pain. The initial assessment revealed a positive Murphy's sign, elevated white blood count, and a cholestatic pattern on liver function tests, leading one to suspect bacterial calculous cholecystitis and initiating antibiotic therapy. However, clinical examination also revealed tonsillar exudates and differential white blood cell count revealed monocytosis and lymphocytosis rather than a high neutrophil count. The patient tested positive for EBV. Furthermore, ultrasound and magnetic resonance imaging revealed gallbladder wall edema with no gallstones, leading one to conclude that the clinical manifestation and laboratory results were due to an EBV infection. Antibiotic therapy was ceased and the patient did not require surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Calculous bacterial cholecystitis usually entails antibiotic therapy and cholecystectomy. It is important to be aware of the differential diagnosis of EBV, as it usually does not require either of these and resolves spontaneously.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:66 |
|---|---|
| Enthalten in: |
The Journal of emergency medicine - 66(2024), 3 vom: 15. März, Seite e365-e368 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Khan, Umael [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Abdominal pain |
|---|
| Anmerkungen: |
Date Completed 20.03.2024 Date Revised 20.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jemermed.2023.10.005 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM369137566 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM369137566 | ||
| 003 | DE-627 | ||
| 005 | 20240320234440.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240301s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jemermed.2023.10.005 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1337.xml |
| 035 | |a (DE-627)NLM369137566 | ||
| 035 | |a (NLM)38423863 | ||
| 035 | |a (PII)S0736-4679(23)00493-6 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Khan, Umael |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Epstein-Barr in a Patient Presenting with Right Upper Quadrant Pain |b A Case Report from the Emergency Department |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 20.03.2024 | ||
| 500 | |a Date Revised 20.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Right upper quadrant abdominal pain and elevated cholestasis blood tests are usually associated with bacterial calculous cholecystitis. However, viral infections, such as Epstein-Barr virus (EBV) can also manifest with a similar clinical picture and is an important differential diagnosis | ||
| 520 | |a CASE REPORT: This case report discusses a young woman presenting to the emergency department with acute right upper quadrant abdominal pain. The initial assessment revealed a positive Murphy's sign, elevated white blood count, and a cholestatic pattern on liver function tests, leading one to suspect bacterial calculous cholecystitis and initiating antibiotic therapy. However, clinical examination also revealed tonsillar exudates and differential white blood cell count revealed monocytosis and lymphocytosis rather than a high neutrophil count. The patient tested positive for EBV. Furthermore, ultrasound and magnetic resonance imaging revealed gallbladder wall edema with no gallstones, leading one to conclude that the clinical manifestation and laboratory results were due to an EBV infection. Antibiotic therapy was ceased and the patient did not require surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Calculous bacterial cholecystitis usually entails antibiotic therapy and cholecystectomy. It is important to be aware of the differential diagnosis of EBV, as it usually does not require either of these and resolves spontaneously | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a EBV | |
| 650 | 4 | |a Epstein-Barr | |
| 650 | 4 | |a abdominal pain | |
| 650 | 4 | |a acalculous cholecystitis | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Aarebrot, Anders |e verfasserin |4 aut | |
| 700 | 1 | |a Mo, Solveig |e verfasserin |4 aut | |
| 700 | 1 | |a Landa, Signe |e verfasserin |4 aut | |
| 700 | 1 | |a Rösler, Cornelia |e verfasserin |4 aut | |
| 700 | 1 | |a Sodha, Ole Kamal |e verfasserin |4 aut | |
| 700 | 1 | |a Bjørneklett, Rune |e verfasserin |4 aut | |
| 700 | 1 | |a Dizdar, Vernesa |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Journal of emergency medicine |d 1993 |g 66(2024), 3 vom: 15. März, Seite e365-e368 |w (DE-627)NLM012713112 |x 0736-4679 |7 nnns |
| 773 | 1 | 8 | |g volume:66 |g year:2024 |g number:3 |g day:15 |g month:03 |g pages:e365-e368 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jemermed.2023.10.005 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 66 |j 2024 |e 3 |b 15 |c 03 |h e365-e368 | ||