SYMPTOMATIC INTERLEUKIN-2-INDUCED CHOLECYSTOPATHY IN PATIENTS WITH HIV-INFECTION

OBJECTIVE. This study reports the clinical and radiologic findings in seven patients infected with HIV who had 10 consecutive episodes of sy mptomatic cholecystopathy induced by infusion of interleukin-2. SUBJEC TS AND METHODS. Ten episodes of right upper quadrant pain associated w ith gallbladder wall thickening were seen in seven of 29 HIV-infected patients who received IV interleukin-2. Patients received 6-18 million IU/day of continuous interleukin-2 infusion for 5 days. Patients with right upper quadrant pain underwent sonographic examinations, which w ere interpreted prospectively. Medical records and previous sonographi c studies were reviewed retrospectively. Follow-up was obtained throug h outpatient visits and sonography. RESULTS. Right upper quadrant pain during these 10 episodes of cholecystopathy usually developed 4-5 day s after starting infusion of interleukin-2. Sonography during that tim e showed gallbladder wall thickening (mean thickness, 12.4 mm; range, 5-18 mm) and a wide variety of sonographic appearances. Tenderness dur ing sonography was focal in six episodes, diffuse in one, and absent i n three. Sludge was identified in one episode; calculi were not seen, Findings on radionuclide biliary scans were normal in three cases. Sym ptoms abated rapidly in every case after infusion of interleukin-a was reduced or stopped. No surgery was necessary. When treatment was repe ated, three patients had recurrent episodes, with clinical courses and sonographic aberrations showing little variance from the initial epis odes, Follow-up sonography in three episodes showed a maximal thicknes s of the gallbladder wall of 4 mm, No patient had a history or laborat ory evidence of intrinsic biliary disease. CONCLUSION, Symptomatic thi ckening of the gallbladder wall during infusion of interleukin-2 can e xactly mimic other forms of acalculous cholecystitis, except that when associated with interleukin-2 the thickening is rapidly reversible an d surgery is not required. Radionuclide scans can be useful in clinica l decision making. The process appears to be benign, and cessation of interleukin-2 therapy, along with close clinical observation, appears to be the appropriate treatment.