Salvato P, Thompson C, Stroud S, Knight B, Hasheeve D; International Conference on AIDS.
Int Conf AIDS. 1993 Jun 6-11; 9: 440 (abstract no. PO-B19-1829).
Houston Immunological Institute, Texas.
OBJECTIVE: To describe occult infections and cancers associated with acalculous cholecystitis in patients with HIV disease. METHODS: A retrospective review of 47 charts over a two-year period. Patients were HIV+ (3:CD4 > 500, 12:CD4 200-500, 32:CD4 < 200) with abdominal pain and fevers. All patients had liver function tests, ultrasound or CAT scan of the abdomen and nuclear medicine scans (HIDA). Diagnosis was made on histologic and culture sections of the gallbladder or surrounding lymph nodes and pericholecystic fluid. RESULTS: The most commonly elevated liver function test was the Alk Phos which was 2-5 x normal range with highest levels in MAIC patients. Occasionally, the bilirubin was elevated (9/47) in the range of 2-4 x normal. Ultrasound disclosed pathology in 27 patients, CAT scan in 32 patients and HIDA scan in 41 patients. Common ultrasound and CAT scan findings were thickening of the gallbladder wall, air in the wall, narrowing of the lumen, pericholecystic fluid and lymphadenopathy. HIDA scans showed absence of gallbladder visualization. Infections included CMV (3), MAIC (20), Cryptosporidium (3), Salmonella (1), and Pseudomonas (1). Lymphoma was identified in 2 patients and KS in 2 others. In 15 patients, no etiology was found. CD4 counts < 200 were mainly associated with MAIC and lymphoma, while cases of CMV, cryptosporidium, KS, and bacterial causes were seen across all CD4 counts. CONCLUSIONS: Acalculous Cholecystitis is a cause of fever and abdominal pain in patients with HIV infections. HIDA scans more reliably demonstrated pathology than either ultrasound or CAT scans. Patients with AIDS-associated biliary disease have fever, pain, and dramatic increases in serum Alk Phos levels. The majority (32/47) have an established etiology to their cholecystitis. Obstructive biliary disease should be thoroughly evaluated in HIV patients in search of a treatable etiology. CD4 counts did not accurately predict the pathogen, although MAIC and lymphoma were greater in the < 200 CD4 count group.
Publication Types:
Keywords:
- Abdominal Pain
- Acalculous Cholecystitis
- Acquired Immunodeficiency Syndrome
- Animals
- Biliary Tract Diseases
- CD4 Lymphocyte Count
- Cats
- Cholecystitis
- Gallbladder
- HIV Infections
- HIV Seropositivity
- Humans
- Imino Acids
- lidofenin
- ultrasonography
Other ID:
UI: 102204793
From Meeting Abstracts