Primary Epstein-Barr virus-associated acute acalculous cholecystitis and Gianotti-Crosti syndrome

A 15-year-old boy presented with fever, upper respiratory tract symptoms, cervical lymphadenopathy, and vague abdominal symptoms. Abdominal ultrasound findings were consistent with acute acalculous cholecystitis. Serology was positive for acute Epstein-Barr virus (EBV) infection. The patient recovered and was discharged, but returned 1 week later with an acute, symmetric, papulovesicular exanthem on his forearms and lower legs, which was consistent with Gianotti-Crosti syndrome. Although the latter is not uncommonly associated with EBV infection, acalculous cholecystitis of viral origin is exceedingly rare in children.