Acute acalculous cholecystitis in children due to EBV and cytomegalovirus infection: a rare case report and review of the literature.

Epstein-Barr virus (EBV) is a B-cophilic double-stranded DNA virus with strong susceptibility throughout the world. Among young children under 6 years old, primary EBV infections are mostly recessive, In older children, EBV infection often involves multiple systems, presents as infectious mononucleosis (50%), chronic active EBV Infection, hemophagocytic syndrome, tumor-related diseases and autoimmune diseases, etc. Cytomegalovirus (CMV) is another common pathogen causing infectious mononuclear cytopathic syndrome, which is prone to missed diagnosis in clinical practice. Acute cholecystitis in children is rare in clinical practice. Diseases with related cross-clinical manifestations are prone to missed diagnosis and misdiagnosis. We report the case of a 7-year-old boy with AAC occurring during IM caused by EBV and CMV coinfection. He presented with fever, cervical lymphadenopathy, abdominal pain, abnormal liver function, and gallbladder wall thickening without gallstones. After the diagnosis was clarified, antibiotics were discontinued and the patient improved with conservative treatment alone. This case highlights that EBV/CMV-associated AAC should be considered in children with IM who develop right upper abdominal pain, in order to avoid unnecessary antibiotic exposure and surgical intervention.