Gallbladder Wall Thickening in an Adolescent With Acute Mononucleosis: A Case Report and Brief Review of the Literature

A 17-year-old female was admitted to our hospital with a 5-day history of fever (Tmax of 38.5 o C), asthenia, and nausea, accompanied by right upper quadrant abdominal pain, back pain, emesis, and jaundice during the previous 24 hours. On physical exam at the time of presentation, she was a tall and thin adolescent with a body mass index of 14.5. She was ill-appearing with scleral icterus, scant shotty cervical lymphadenopathy, and had an abdominal exam remarkable for right upper quadrant tenderness to palpation. She had no appreciable hepatosplenomegaly. The rest of her physical exam was unremarkable. Results of the patient’s laboratory evaluation revealed a white blood cell count (WBC) of 5100 WBC/mcL (neutrophils 27%, bands 8%, lymphocytes 44%, monocytes 2%, eosinophils 1%, atypical lymphocytes 18%), hemoglobin of 9.9 g/dL, and platelets of 106 000/mL, normal electrolytes, aspartate aminotransferase (AST) level of 222 U/L, alanine aminotransferase (ALT) level of 194 U/L, total bilirubin level of 11.2 mg/dL, conjugated bilirubin level of 8.7 mg/dL, albumin level of 2.8 g/dL, alkaline phosphatase level of 130 U/L, and γ-glutamyl transferase level of 89 U/L. Electrolytes, amylase, and lipase were within normal limits. The heterophile antibody test was negative. Urinalysis showed large bilirubin, but it was otherwise normal.