Novel coronavirus disease or 2019 coronavirus disease (COVID-19) is caused by the 2019-severe acute respiratory syndrome coronavirus 2 (2019-SARS-CoV2), and typically manifests with systemic symptoms like fever and myalgia as well as respiratory symptoms including dry cough, dyspnoea and anosmia [1] .
Reports suggest that lineage B β-coronaviruses that are highly pathogenic to humans such as the 2002-SARS-CoV1 and 2019-SARS-CoV2 can affect the liver and induce acute hepatitis [2, 1] . Herein, we report the cases of two patients who developed COVID-19 presenting as an acute acalculous cholecystitis.
The first case was an 84-year-old female patient who presented to our emergency department with symptoms and signs of urinary tract infection and fever (38.5 ˚C) for 24 hours. Sepsis due to pyelonephritis was the initial diagnosis after a pathological urinalysis and positive urine culture. Blood tests revealed a slight cytolysis. Ceftriaxone was initiated alongside supportive care.
On day 3, a right upper quadrant pain emerged, and on day 5, a positive Murphy sign was detected along with an increase in CRP, reaching 249.3 mg/l (Table S1) SARS coronaviruses have a tropism to the lungs but also to the liver [1] . Indeed, the intracellular entry of the virus occurs through interaction with the angiotensin-converting enzyme 2 receptor (ACE2) which is present in several tissues, including lungs and liver [1] . In 2002-SARS-CoV autopsies, liver tissue exhibited different patterns of hepatocyte injuries, and viral RNA was found inside hepatocytes [3] . Both 2002-SARS-CoV and 2019-SARS-CoV-2 are characterized by cytolysis with mild elevation of AST and ALT levels [4, 5] .
Moreover, angiotensin-converting enzyme 2 receptor levels are higher in bile duct cells and Xu et al. suggested that liver injury induced by highly pathogenic SARS coronaviruses may be due to a direct harm to bile duct cells [5] . COVID-19 related acalculous cholecystitis was presented in few case reports and managed with surgery or gallbladder percutaneous drainage [6, 7] . Ying et al. 
For the first patient, consent for case publication was obtained from patient family and care representant as patient was deceased. For the second case, consent was directly obtained from the patient himself. All data, including radiology images were anonymized.
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