Conservative Treatment of HAV-Associated Acalculous Acute Cholecystitis in an Adult: A Case Report.

Hepatitis A virus (HAV) is a viral infection that can present with a wide range of clinical manifestations, including rare complications such as acute acalculous cholecystitis (AAC). We present the case of a 31-year-old woman who arrived at the emergency department with severe epigastric pain, fever, early satiety, nausea, and vomiting. Physical examination revealed a positive Murphy's sign, hepatomegaly, and epigastric tenderness, suggesting obstructive acute cholecystitis. Imaging studies showed reactive changes in the gallbladder and mild dilation of the intrahepatic bile ducts. Laboratory tests indicated elevated bilirubin levels and a cholestatic pattern with markedly increased transaminases. Magnetic resonance cholangiopancreatography confirmed AAC and ruled out biliary obstruction. Positive serology for Hepatitis A led to the definitive diagnosis of AAC secondary to Hepatitis A. Treatment focused on supportive care with intravenous hydration and symptomatic management, avoiding antibiotics due to the self-limiting nature of the viral infection. The patient showed a favorable clinical course, with a progressive decrease in gallbladder diameter and normalization of liver parameters. This case highlights the importance of considering rare viral infections as a cause of AAC and demonstrates that a conservative approach can be effective in managing this condition. This case underscores the importance of considering viral etiologies, particularly HAV, in the differential diagnosis of AAC in adults. It further demonstrates that, in carefully selected patients, conservative management can be both safe and effective, thereby avoiding unnecessary antibiotic use or surgical intervention in the context of a self-limiting viral infection.