AJR Am J Roentgenol. 1994 Jul;163(1):117-21. Unique Identifier :
OBJECTIVE. This study reports the clinical and radiologic findings in
seven patients infected with HIV who had 10 consecutive episodes of
symptomatic cholecystopathy induced by infusion of interleukin-2.
SUBJECTS AND METHODS. Ten episodes of right upper quadrant pain
associated with 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 were interpreted prospectively. Medical records and
previous sonographic studies were reviewed retrospectively. Follow-up
was obtained through outpatient visits and sonography. RESULTS. Right
upper quadrant pain during these 10 episodes of cholecystopathy usually
developed 4-5 days after starting infusion of interleukin-2. Sonography
during that time showed gallbladder wall thickening (mean thickness,
12.4 mm; range, 5-18 mm) and a wide variety of sonographic appearances.
Tenderness during sonography was focal in six episodes, diffuse in one,
and absent in three. Sludge was identified in one episode; calculi were
not seen. Findings on radionuclide biliary scans were normal in three
cases. Symptoms abated rapidly in every case after infusion of
interleukin-2 was reduced or stopped. No surgery was necessary. When
treatment was repeated, three patients had recurrent episodes, with
clinical courses and sonographic aberrations showing little variance
from the initial episodes. Follow-up sonography in three episodes showed
a maximal thickness of the gallbladder wall of 4 mm. No patient had a
history or laboratory evidence of intrinsic biliary disease. CONCLUSION.
Symptomatic thickening of the gallbladder wall during infusion of
interleukin-2 can exactly mimic other forms of acalculous cholecystitis,
except that when associated with interleukin-2 the thickening is rapidly
reversible and surgery is not required. Radionuclide scans can be useful
in clinical 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.
Abdominal Pain/ETIOLOGY Adult Drug Administration Schedule Female
Diseases/EPIDEMIOLOGY/*ETIOLOGY/ULTRASONOGRAPHY Human HIV
Infections/*THERAPY Infusions, Intravenous
Interleukin-2/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS/ THERAPEUTIC USE
Male Prospective Studies Retrospective Studies CLINICAL TRIAL