International Journal of Contemporary Pediatrics | March 2022 | Vol 9 | Issue 3 Page 274 International Journal of Contemporary Pediatrics Vageriya NL et al. Int J Contemp Pediatr. 2022 Mar;9(3):274-278 http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291 Case Series Case series of paediatric patients of acute acalculous cholecystitis associated with severe malaria in endemic region over past 3 years at single center Natasha L. Vageriya, Lamia Inayath*, Hemangi Athawale, Taha Daginawala, Shweta Tewari, Shivaji Mane INTRODUCTION AAC is responsible for only 2-15% cases of acute cholecystitis across all age groups. 1,2 It is mainly limited to critically ill, trauma, burns or septic patients. Its association with malaria is uncommon. As symptoms of pain in abdomen are present in majority cases of malaria not all patients undergo ultrasound examination; which may be the cause for its underreporting. ACC can have a very high complication, morbidity, and mortality rates. 1,3 Timely diagnosis and determination of the underlying etiology is crucial. Although the standard of treatment for AAC is urgent cholecystectomy or percutaneous cholecystostomy in adults, non-operative management with appropriate antibiotic therapy should be considered for paediatric patients with infectious ACC especially when associated with malaria. We report 7 such children with high grade fever; diagnosed of malaria (6: falciparum; 1 with combined vivax and dengue) developing ACC. All were managed conservatively with analgesia, rehydration, intravenous anti-malarial and antibiotics followed by enteral antibiotics. They were kept under strict clinical and imaging observation and recovered without any surgical intervention. At a mean follow up of 1 year they are asymptomatic with a normal ultrasound imaging. CASE SERIES We are reporting a series of 7 paediatric patients developing ACC secondary to and associated with severe malaria over past 3 years at a single centre (Table 1). Their age ranged from 9 months to 9 years. Three of them were boys and four were girls. All of them were symptomatic with high grade fever, vomiting, pain in abdomen and 3 children of them also had drowsiness and irritability. All of these 3 had normal computed tomography of brains, and hypotension requiring fluid resuscitation. Only 2 of altered sensorial patients required dopamine support initially. Of these 1 also had acute renal failure for which he needed peritoneal dialysis for 5 days later the renal output improved. All patients came positive for Plasmodium falciparum infection except one who had Plasmodium vivax along with Dengue NS1 antigen positive. Covid swab of all these patients were negative on two occasions 4 days apart. All of them had a Department of Paediatric Surgery, Government Grant Medical college and JJ Hospitals, Mumbai, Maharashtra, India Received: 01 February 2022 Accepted: 16 February 2022 *Correspondence: Dr. Lamia Inayath, E-mail: lamiinayath@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Although acute acalculous cholecystitis (AAC) is a rare occurrence in all age groups; its incidence in paediatric patients is 50-60%. Yet ACC in children with malarial parasitic infection is extremely rare with only 12 cases reported as per English literature. We report 7 children with severe malaria developing ACC in a single institute in India over past 3 years. They were managed conservatively under strict observation and recovered completely without any surgical intervention. At a mean follow up of 1.5 years they are asymptomatic with a normal ultrasound imaging. Keywords: AAC, Malaria, Falciparum, Paediatric DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20220453