Fever in Cholecystitis
Yes, fever occurs in acute cholecystitis, but it is present in only 36-74% of patients, and high-grade fever (>38°C) is uncommon, occurring in just 6.4-10% of cases. 1
Clinical Presentation of Fever
Fever is recognized as a systemic sign of inflammation commonly present in acute cholecystitis and is part of the diagnostic criteria. 2
The Infectious Diseases Society of America (2024) identifies fever as one of the cardinal clinical signs of acute cholangitis (along with jaundice, chills, and right upper quadrant pain), though this guideline focused primarily on cholangitis rather than cholecystitis. 1
The Tokyo Guidelines establish that fever, along with elevated white blood cell count and elevated C-reactive protein, constitutes one of the systemic signs of inflammation used to diagnose acute cholecystitis. 3
Diagnostic Implications
No single clinical finding, including fever, has sufficient diagnostic power to establish or exclude acute cholecystitis. 1
A combination of clinical features (right upper quadrant pain, Murphy's sign, fever), laboratory tests (elevated WBC in 55% of cases, elevated CRP in 68%), and imaging findings is necessary for accurate diagnosis. 2, 4
The absence of fever should not exclude the diagnosis—approximately 26-64% of patients with confirmed acute cholecystitis present without fever. 1
Common Clinical Pitfalls
Do not rely on fever alone to make or exclude the diagnosis of cholecystitis—the typical presentation includes right upper quadrant pain (72-93% of patients), which is far more consistent than fever. 1
Patients who have received antipyretics or pain medication prior to examination may have blunted fever response despite active inflammation. 2
In elderly patients, fever patterns are similar to younger patients, though elderly patients may develop more severe forms (gangrenous cholecystitis) that paradoxically present with higher inflammatory markers. 1
Practical Diagnostic Approach
When evaluating suspected cholecystitis, assess for the triad of right upper quadrant pain/tenderness, systemic signs of inflammation (fever, leukocytosis, elevated CRP), and Murphy's sign. 2, 3
Proceed to abdominal ultrasound as the initial imaging modality (sensitivity ~81%, specificity ~83%) regardless of whether fever is present or absent. 5
If ultrasound is equivocal and clinical suspicion persists, obtain CT imaging or hepatobiliary scintigraphy for definitive diagnosis. 1, 5