New York-Presbyterian/Weill Cornell Medical Center New York, NY
Nabeel Wahid, MD1, Tanya Bhardwaj, MD1, Carly Borinsky, MD1, Montreh Tavakkoli, MD1, David Wan, MD2, Tanping Wong, MD1; 1New York-Presbyterian/Weill Cornell Medical Center, New York, NY; 2Weill Cornell Medical College, Cornell University, New York, NY
Introduction: Reported gastrointestinal manifestations from COVID-19 include transaminitis, acute hepatitis, and mild pancreatic injury; but biliary manifestations have not been reported. In this case report, we describe two cases of acute acalculous cholecystitis (AAC) in patients with prolonged hospitalizations for COVID-19.
Methods: A 60-year-old woman with hypertension, type 2 diabetes and hypothyroidism and separately, a 68-year-old man with hypertension, hyperlipidemia, asthma, and obstructive sleep apnea were both admitted during the peak of the SARS-CoV2 pandemic in New York City for acute hypoxic respiratory failure secondary to acute respiratory distress syndrome (ARDS) from COVID-19 pneumonia. Both patients were diagnosed with acute acalculous cholecystitis on a general medicine service after a prolonged hospital course including mechanical ventilation (Table 1). Both patients improved clinically after placement of a cholecystostomy tube and antibiotics. Discussion: Acute acalculous cholecystitis accounts for 2-15% of all cases of acute cholecystitis and results from ischemia and stasis of the gallbladder, often from critical illness. Whereas AAC has been described in a variety of clinical settings including trauma, recent surgery, sepsis and enteral fasting, it has not been described in the context of severe COVID-19 infection requiring prolonged hospitalization. It is unclear whether AAC is a direct manifestation of the SARS-CoV2 virus directly or a consequence of prolonged illness from the virus. Notably, both of our patients had long ICU stays for COVID-19 but were diagnosed with AAC when they were more clinically stable on a non-ICU medicine service, suggesting that this manifestation may not be merely from severe critical illness alone. In patients with a strong clinical suspicion, including new leukocytosis and right upper quadrant pain or bacteremia with gastrointestinal pathogens, providers should not be reassured by non-diagnostic CT or ultrasound imaging because none of these imaging modalities have good sensitivity for AAC. COVID-19 is proving to have multiorgan manifestations during its disease course and providers should not fail to recognize biliary complications such as acute acalculous cholecystitis. Further studies are necessary to assess the incidence of AAC in patients with prolonged hospitalization from COVID-19.
Table 1: Summary of clinical characteristics at time of diagnosis of AAC
Disclosures: Nabeel Wahid indicated no relevant financial relationships. Tanya Bhardwaj indicated no relevant financial relationships. Carly Borinsky indicated no relevant financial relationships. Montreh Tavakkoli indicated no relevant financial relationships. David Wan indicated no relevant financial relationships. Tanping Wong indicated no relevant financial relationships.