To the Editor: A 5-y-old girl presented to the emergency department due to fever up to 40
o C which started 2 d prior together with sore throat and abdominal pain. Physical examination revealed exudative pharyngitis, enlarged spleen and cervical lymph nodes. Laboratory investigation showcased increased white blood cells (18,000/µL) with low C-reactive protein (< 0.69 mg/dL) and a positive strep test. Furthermore, the patient was started on antibiotics, however the fever did not subside, leading us to consider alternate causative agents. IgM and IgG antibodies against Ebstein Barr virus were positive on the 2nd day of hospitalization. During the patient’s stay at the hospital, abdominal pain exacerbated as a symptom especially on the 4th day together with an increase in her liver enzymes. Immediate ultrasound was performed revealing findings indicative of acalculous cholecystitis (gallbladder wall thickness 1 cm, presence of mucosal membrane sludge and gallbladder distention) [
1]. The patient was at first placed on nil by mouth and received intravenous fluids with gradual transition to a gallbladder disease diet in accordance with a dietologist’s advice, leading to a progressive clinical and laboratory improvement. …
