Acute Acalculous Cholecystitis in Dengue Fever: An Emerging Clinical Entity

Abstract

Background: Dengue fever is a mosquito-borne viral disease that presents with a wide range of clinical manifestations, varying from mild febrile illness to severe systemic involvement. Although acute acalculous cholecystitis is classically observed in critically ill patients, it has recently emerged as a notable complication associated with dengue infection.

Objective: This study aimed to determine the incidence, clinical characteristics, treatment approaches, and outcomes of patients with acute acalculous cholecystitis secondary to dengue fever.

Methods: A retrospective study was carried out in the Critical Care Unit of Dhaka National Medical College Hospital over a 24-month period (August 2023 to July 2025). A total of 222 patients diagnosed with dengue fever confirmed by positive dengue NS1 antigen or IgM antibody tests were included after requiring surgical consultation. Clinical records, laboratory findings, and abdominal ultrasonography reports were reviewed. Acute acalculous cholecystitis was identified based on clinical presentation and sonographic findings. Data were analyzed descriptively and presented in tables and figures.

Results: Among the 222 confirmed dengue cases, 62 patients (27.9%) developed acute acalculous cholecystitis. The cohort included 36 males and 26 females. The mean time from fever onset to hospital presentation was 3.7 days (range 3–5 days). The average white blood cell count was 4216 ± 1374.7 /cm³ and the mean platelet count was 23,757 ± 12,440.5 /cm. All patients presented with fever and headache (100%), while myalgia and arthralgia were observed in 90.5% and 89.2% respectively. Nausea and vomiting occurred in 87.8%, and abdominal pain was reported by 34.2%. Skin rash was noted in 11.7% of patients. Ultrasonography revealed gallbladder wall thickening in all 62 cases, pericholecystic fluid in 56 (25.2%), and a positive sonographic Murphy’s sign in 51 (23.0%); no gallstones were detected. Mild to moderate ascites was present in 31 (14.0%) patients, hepatomegaly in 25 (11.3%), splenomegaly in 16 (7.2%), and mild pleural effusion in 24 (10.8%). The mean gallbladder wall thickness measured 6.1 ± 1.5 mm. All patients were successfully managed conservatively, without surgical intervention.

Conclusion: Acute acalculous cholecystitis represents an under recognized but significant manifestation of dengue fever. Prompt ultrasonographic evaluation facilitates early detection, and conservative treatment strategies generally lead to favorable outcomes, thereby reducing unnecessary surgical procedures.

J Dhaka National Med. Coll. Hos. 2026; 32 (01): 07-11