"Acute Acalculous Cholecystitis Due to Covid-19: A Case Report"

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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered in Wuhan, China, in late December 2019.It has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19).Besides pulmonary involvement, SARS-CoV-2 may affect other organs such as the liver, and rarely the gallbladder. Case Presentation:We report a case of a healthy 52-year-old man who was diagnosed with mild COVID-19 pneumonia.He developed progressive onset of rightsided hypochondrial pain during his hospital stay.Abdominal ultrasound and CT scan revealed acute acalculous cholecystitis (AAC).IV antibiotics were initiated but there was no clinical improvement, so surgery was decided.Intraoperative exploration revealed a distended gallbladder with gangrenous and thickened wall and emergent cholecystectomy was performed.Discussion: COVID-19 infection presenting with gallbladder involvement with acute acalculous cholecystitis is extremely rare.To our knowledge, only 10 cases were reported in the medical literature, since the pandemic declaration.While most of these cases were described in critically ill patients with long intensive care unit (ICU) stays, we report the third case of AAC on a healthy patient with mild COVID-19 pneumonia, who did not develop acute respiratory distress syndrome.By reviewing the recent literature, we noticed that the potential mechanisms of COVID-19-associated acalculous cholecystitis in non-ICU setting patients may include the direct effects of viral infection, inflammatory storm and endotheliitis.Conclusion: Through our case, we aim to highlight the importance of early detection and prompt management of biliary complications such as acute acalculous cholecystitis.As the pandemic continues to spread, further data are necessary to accurately assess the physiopathogenesis of hepatobiliary injury.