Published: 2022-11-24

Acalculous cholecystitis in the setting of immunoglobulin a vasculitis: a case report with literature review

Clayton Prakash Burruss, Ioana Bacus, Pooja Dushyant Utamsingh


Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein Purpura, is the most common childhood vasculitis which presents with a tetrad of symptoms: palpable purpura, abdominal pain, arthralgias, and renal involvement. Gastrointestinal involvement has been reported with findings including abdominal pain, pancreatitis, intussusception, ischemia, and gallbladder involvement. Our patient had the classical presentation of IgAV with additional gallbladder thickening found on imaging. He was managed conservatively for his symptoms and gallbladder thickening. This case adds to the six prior cases that we found in our literature search reported of gallbladder thickening alongside IgAV. However, this was the only case that was managed conservatively resulting in a complete resolution of symptoms.


IgAV vasculitis, Henoch-Schönlein Purpura, Acalculous cholecystitis

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Oni L, Sampath S. Childhood IgA Vasculitis (Henoch Schonlein Purpura)-Advances and Knowledge Gaps. Front Pediatr. 2019;7:257.

Gardner-Medwin JMM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet Lond Engl. 2002;360(9341):1197-202.

Watson L, Richardson ARW, Holt RCL, Jones CA, Beresford MW. Henoch schonlein purpura--a 5-year review and proposed pathway. PloS One. 2012;7(1):e29512.

Kaswala D, Chodos A, Ahlawat S. Henoch-Schonlein Purpura with Gastrointestinal Involvement in an Adult Patient. Gastroenterol Hepatol. 2016;12(5):321-323.

Branski D, Gross V, Gross-Kieselstein E, Roll D, Abrahamov A. Pancreatitis as a complication of Henoch-Schonlein purpura. J Pediatr Gastroenterol Nutr. 1982;1(2):275-6.

Cheung KM, Mok F, Lam P, Chan KH. Pancreatitis associated with Henoch-Schonlein purpura. J Paediatr Child Health. 2001;37(3):311-13.

Zhao Q, Yang Y, He SW, Wang XT, Liu C. Risk factors for intussusception in children with Henoch-Schönlein purpura: A case-control study. World J Clin Cases. 2021;9(22):6244-53.

Prathiba Rajalakshmi P, Srinivasan K. Gastrointestinal manifestations of Henoch-Schonlein purpura: A report of two cases. World J Radiol. 2015;7(3):66-9.

Kumon Y, Hisatake K, Chikamori M. A case of vasculitic cholecystitis associated with Schönlein-Henoch purpura in an adult. Gastroenterol Jpn. 1988;23(1):68-72.

Amemoto K, Nagita A, Aoki S, Azumagawa K, Hirano K, Mino M. Ultrasonographic gallbladder wall thickening in children with Henoch-Schonlein purpura. J Pediatr Gastroenterol Nutr. 1994;19(1):126-8.

Bacelli S, Annibali R, Gatti S, et al. A case of acute cholecystitis in Henoch-Schönlein purpura. Dig Liver Dis. 2013;45:e305-6.

Özkaya AK, Güler E, Çetinkaya A. Henoch-Schönlein purpura complicated by acalculous cholecystitis and intussusception, and following recurrence with appendicitis. Paediatr Int Child Health. 2016;36(2):157-9.

Hoffmann JC, Cremer P, Preiss JC. Gallbladder involvement of Henoch-Schönlein purpura mimicking acute acalculous cholecystitis. Digestion. 2004;70(1):45-8.

Johnson EF, Lehman JS, Wetter DA, Lohse CM, Tollefson MM. Henoch–Schönlein purpura and systemic disease in children: retrospective study of clinical findings, histopathology and direct immunofluorescence in 34 paediatric patients. Br J Dermatol. 2015;172(5):1358-63.

Yang YH, Hung CF, Hsu CR. A nationwide survey on epidemiological characteristics of childhood Henoch-Schönlein purpura in Taiwan. Rheumatol Oxf Engl. 2005;44(5):618-22.

Lei WT, Tsai PL, Chu SH. Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database. Pediatr Rheumatol. 2018;16(1):25.

Leung AKC, Barankin B, Leong KF. Henoch-Schönlein Purpura in Children: An Updated Review. Curr Pediatr Rev. 2020;16(4):265-76.

Saulsbury FT. Clinical update: Henoch-Schönlein purpura. Lancet Lond Engl. 2007;369(9566):976-8.

Chen SY, Kong MS. Gastrointestinal manifestations and complications of Henoch-Schönlein purpura. Chang Gung Med J. 2004;27(3):175-81.

Ghrahani R, Ledika MA, Sapartini G, Setiabudiawan B. Age of onset as a risk factor of renal involvement in Henoch-Schönlein purpura. Asia Pac Allergy. 2014;4(1):42-7.

Trapani S, Micheli A, Grisolia F. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005;35(3):143-53.

Laurila J, Syrjälä H, Laurila PA, Saarnio J, Ala-Kokko TI. Acute acalculous cholecystitis in critically ill patients. Acta Anaesthesiol Scand. 2004;48(8):986-91.

Poddighe D, Sazonov V. Acute acalculous cholecystitis in children. World J Gastroenterol. 2018;24(43):4870-9.

Balmadrid B. Recent advances in management of acalculous cholecystitis. F1000Research. 2018;7:F1000-660.

Garcia-Fuentes M, Martin A, Chantler C, Williams DG. Serum complement components in Henoch-Schönlein purpura. Arch Dis Child. 1978;53(5):417-9.