Acute cholecystitis in AIDS patients: Correlation of Tc-99m hepatobiliary scintigraphy with histopathologic laboratory findings and CD4 counts

Background: AIDS patients are susceptible to opportunistic gastrointestinal infections including ascending cholangitis and cholecystitis, especially if CD4 count is <200. incidence of acalculous cholecystitis has not been reported previously. Purpose: We aim to evaluate the incidence of acalculous cholecystitis in AIDS patients and to identify causative organisms and mortality rate following cholecystectomy. Materials and Methods: We reviewed the files of 46 patients in order to meet the objectives of this study. Results: CD4 counts were <200 in 31 patients and >200 in 15 patients. HIDA imaging was performed in 31 patients; in 8, the CD4 count was >200 and all had calculous cholecystitis. The gallbladder was visualized in 3 patients for a sensitivity of 63% and no organisms were found in the gallbladder specimens. In 23 patients, the CD4 count was <200; the gallbladder was visualized in 5 patients for a HIDA sensitivity of 78%; 16 (52%) had acalculous cholecystitis, Cryptosporidium was found in six cases, cytomegalovirus (CMV) in six cases, and fungus, yeast, tuberculosis, and mycobacterium avium intracellular each in one case. The thirty day mortality rate was 18%; 5 of 28 who underwent open cholecystectomy died within 30 days, 4 of them with a CD4 count <200. There was no mortality in the 26 patients who underwent laparoscopic cholecystectomy. Conclusion and Recommendations: (1) Because of the high incidence of 52% of acalculous cholecystitis in AIDS patients with a CD4 count <200, we recommend using intravenous cholecystokinin if the gallbladder is visualized on hepatobiliary scintigraphy in order to determine gallbladder ejection fraction and exclude acalculous cholecystitis. (2) Laparoscopic rather than open cholecystectomy should be the surgical procedure of choice in AIDS patients especially if the CD4 count is <200.