Gallbladder Involvement in Pediatric Hepatitis A

BACKGROUND: Gallbladder involvement during acute hepatitis A virus (HAV) infection is generally considered an uncommon extrahepatic manifestation, although recent reports suggest it may be underrecognized. We evaluated the prevalence, clinical characteristics and outcomes of gallbladder abnormalities in a multicenter cohort of children hospitalized with acute HAV infection during an Italian outbreak. METHODS: We conducted a multicenter observational study, including consecutive children with laboratory-confirmed acute HAV infection admitted to 4 tertiary pediatric hospitals between January and May 2026. Clinical, laboratory and ultrasonographic findings were collected. All patients underwent abdominal ultrasonography during the acute phase of illness. RESULTS: Thirty-three children were included. Gallbladder abnormalities compatible with acute acalculous cholecystitis were identified in 18 patients (54.5%), including marked gallbladder wall thickening (>7 mm) in 8. Children with gallbladder involvement did not exhibit more severe clinical manifestations or greater biochemical impairment than those without ultrasonographic abnormalities. Serum bile acids were markedly elevated in most tested patients but were not associated with gallbladder abnormalities. All patients were managed conservatively, and none developed gallbladder perforation, empyema, gangrene or required surgical intervention. Complete clinical recovery with progressive normalization of laboratory and ultrasonographic findings was observed in all cases. CONCLUSIONS: Systematic ultrasonography identified gallbladder involvement in more than half of children hospitalized with acute HAV infection, suggesting that this manifestation may be substantially underrecognized rather than truly rare. Despite frequent ultrasonographic abnormalities, the clinical course was uniformly benign, supporting conservative management in the absence of complications.