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 gastrointes tinal infections including ascending cholangitis and cholecystitis, es pecially if CD4 count is <200. incidence of acalculous cholecystitis h as not been reported previously. Purpose: We aim to evaluate the incid ence of acalculous cholecystitis in AIDS patients and to identify caus ative organisms and mortality rate following cholecystectomy. Material s and Methods: We reviewed the files of 46 patients in order to meet t he objectives of this study. Results: CD4 counts were <200 in 31 patie nts and >200 in 15 patients. HIDA imaging was performed in 31 patients ; in 8, the CD4 count was >200 and all had calculous cholecystitis. Th e gallbladder was visualized in 3 patients for a sensitivity of 63% an d 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 intrac ellular 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 w ith a CD4 count <200. There was no mortality in the 26 patients who un derwent laparoscopic cholecystectomy. Conclusion and Recommendations: (1) Because of the high incidence of 52% of acalculous cholecystitis i n AIDS patients with a CD4 count <200, we recommend using intravenous cholecystokinin if the gallbladder is visualized on hepatobiliary scin tigraphy in order to determine gallbladder ejection fraction and exclu de acalculous cholecystitis. (2) Laparoscopic rather than open cholecy stectomy should be the surgical procedure of choice in AIDS patients e specially if the CD4 count is <200.