Fröhlich R, Römmele U
Kreiskliniken Esslingen, Klinik für Innere Medizin Nürtingen.
Dtsch Med Wochenschr. 2013 Jun;138(23):1255-8. doi: 10.1055/s-0033-1343197. Epub 2013 May 29.
Three men, aged 32, 56 and 41 years, respectively, were hospitalized within two weeks because of flu-like symptoms, limb pain and abdominal pain. Being in a febrile, impaired general condition, pressure pains in the upper abdomen and flank pains were particularly noteworthy.
The results of the examinations, indicating acute renal insufficiency, thrombocytopenia and elevated lactate dehydrogenase were typical of a hantavirus infection, and positive serology for the puumala virus confirmed this suspicion. Ultrasonography indicated nephritic changes in all cases. Striking and unusual, however, was the finding of an acalculous cholecystitis.
In one of the three cases, antibiotic therapy with ceftriaxone was performed, in the other two cases symptomatic therapy. The cholecystitis was closely monitored sonographically and healed without complications in all cases.
Hantavirus infections are common in an endemic area such as the Swabian Alb in Southern Germany, but an acalculous cholecystitis was rarely described in such a context. This accumulation is very remarkable, and the knowledge about it can both help to detect complications at an early stage and prevent unnecessary cases of cholecystectomy.
三名男性，年龄分别为32岁、56岁和41岁，在两周内因类似流感症状、肢体疼痛和腹痛入院。发热、全身状况不佳、上腹部压痛和侧腹疼痛尤为值得注意。
检查结果显示急性肾功能不全、血小板减少和乳酸脱氢酶升高，这些都是汉坦病毒感染的典型表现，普马拉病毒血清学检测呈阳性证实了这一怀疑。超声检查显示所有病例均有肾病改变。然而，显著且不寻常的是发现了无结石性胆囊炎。
三例中的一例采用头孢曲松进行抗生素治疗，另外两例采用对症治疗。通过超声密切监测胆囊炎情况，所有病例均无并发症痊愈。
在德国南部施瓦本汝拉山这样的流行地区，汉坦病毒感染很常见，但在这种情况下很少描述无结石性胆囊炎。这种聚集情况非常显著，了解这一点有助于早期发现并发症并预防不必要的胆囊切除术病例。
