P2136 - Acute Acalculous Cholecystitis: An Unusual First Manifestation of COVID-19

Rahul Pamarthy, MD¹, Faisal Inayat, MBBS², Nadeem Hussain, MD², Muhammad Hassan Naeem Goraya, MBBS³, Zahid I. Tarar, MD⁴, Iqra Riaz, MD⁵, Junaid Rasul Awan, MBBS⁶, Zahra Akhtar, MBBS⁷, Muhammad Adnan Zaman, MD⁸, Muhammad Usman Zafar, MD⁹, Abu Hurairah, MD^10
1East Carolina University, Greenville, NC; ²Allama Iqbal Medical College, Lahore, Punjab, Pakistan; ³Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ⁴University of Missouri School of Medicine, Columbia, MO; ⁵Einstein Healthcare Network, Philadelphia, PA; ⁶University Hospital Limerick, Limerick, Limerick, Ireland; ⁷University of Texas Medical Branch, Galveston, Galveston, TX; ⁸Wexham Park Hospital, Slough, England, United Kingdom; ⁹Lehigh Valley Health Network, Allentown, PA; ¹⁰Florida Hospital, Orlando, FL

Introduction: COVID-19 pandemic has become a major global health challenge, with more than 178 million confirmed cases and over 3.86 million deaths to date. While general and respiratory symptoms are common, it may have atypical GI involvement. We chronicle here an extremely rare case of acute acalculous cholecystitis (AAC) in a patient with COVID-19.

Case Description/Methods: A previously healthy 35-year-old male presented to the emergency room with abdominal pain and non-biliary vomiting. He was nonsmoker, nonalcoholic, and drug-free. His vitals revealed: temperature 37.1°C, heart rate 82 bpm, blood pressure 114/72 mm Hg, respiratory rate 16/minute, and an oxygen saturation of 99% in room air. Physical examination revealed a positive Murphy's sign. Laboratory parameters revealed leukocytosis and high CRP level. Abdominal ultrasound showed marked gallbladder wall thickening, normal CBD, with no cholelithiasis or sludge formation. EUS also ruled out stones in the gallbladder. Therein, coronavirus rRT-PCR came back positive. CT chest revealed bilateral patchy peripheral ground-glass opacities in the lungs, consistent with COVID-19. Based on these findings and exclusion of probable causes of AAC, COVID-19-related AAC was diagnosed. The patient was initiated on standard COVID-19 treatment for the mild disease and conservative treatment for AAC. His hospital course remained unremarkable, except for fever and dyspnea on day 4 of admission. He remained hemodynamically stable. On day 7 of admission, his abdominal pain, vomiting, and fever disappeared with treatment. On day 9 of admission, he was afebrile, dyspnea had resolved, and had no abdominal pain. He was then discharged home in a stable condition. He continues to do well for 2 months now.

Discussion: Published medical literature is bereft of reports on the association between AAC and COVID-19. A PubMed search was conducted for all case reports of AAC amidst COVID-19 till June 2021. Search terms included ‘’acalculus cholecystitis’’ and ‘’COVID-19’’. The search resulted in only 4 case reports to date. This case highlights that the GI symptoms may precede the pulmonary manifestations of COVID-19. It further provides the clinical evidence behind a causal relationship between SARS-CoV-2 infection and biliary involvement. The extrapulmonary symptomology of this infection has not been extensively studied, warranting a high index of suspicion for rare manifestations like AAC. Thus, new-onset GI symptoms may indicate COVID-19, requiring prompt testing for SARS-CoV-2.


Disclosures:
Rahul Pamarthy indicated no relevant financial relationships.
Faisal Inayat indicated no relevant financial relationships.
Nadeem Hussain indicated no relevant financial relationships.
Muhammad Hassan Naeem Goraya indicated no relevant financial relationships.
Zahid Tarar indicated no relevant financial relationships.
Iqra Riaz indicated no relevant financial relationships.
Junaid Rasul Awan indicated no relevant financial relationships.
Zahra Akhtar indicated no relevant financial relationships.
Muhammad Adnan Zaman indicated no relevant financial relationships.
Muhammad Usman Zafar indicated no relevant financial relationships.
Abu Hurairah indicated no relevant financial relationships.


Rahul Pamarthy, MD¹, Faisal Inayat, MBBS², Nadeem Hussain, MD², Muhammad Hassan Naeem Goraya, MBBS³, Zahid I. Tarar, MD⁴, Iqra Riaz, MD⁵, Junaid Rasul Awan, MBBS⁶, Zahra Akhtar, MBBS⁷, Muhammad Adnan Zaman, MD⁸, Muhammad Usman Zafar, MD⁹, Abu Hurairah, MD¹⁰. P2136 - Acute Acalculous Cholecystitis: An Unusual First Manifestation of COVID-19, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.