AIDS-related cholangiopathy was common in patients with AIDS prior to the advent of highly active antiretroviral therapy. Mycobacterium avium complex is the most common opportunistic bacterial infection seen in AIDS patients and one of many opportunistic pathogens implicated in AIDS cholangiopathy.

We describe a case of acute cholecystitis secondary to Mycobacterium avium complex in a patient with likely AIDS cholangiopathy. The patient, a 37-year-old Hispanic woman with CD4⁺ of 10 cells/mm³ who was previously diagnosed with disseminated Mycobacterium avium complex, presented with 8 days of diffuse abdominal pain and anorexia. Radiologic imaging suggested acute cholecystitis, so the patient underwent open cholecystectomy. Pathology staining of gall bladder wall revealed acid-fast bacilli consistent with Mycobacterium avium complex. The patient had been receiving appropriate therapy as an outpatient for Mycobacterium avium complex with presumed reliable adherence, but we suggest her burden of disease was high due to her severe immunosuppressive state.

A thorough review of the literature showed that there are many infectious and non-infectious aetiologies for AIDS-associated cholangiopathy. Acute cholecystitis can develop in setting of AIDS cholangiopathy potentially secondary to the opportunistic infection that initially caused the cholangiopathy. Mycobacterium avium complex-related gallbladder disease needs to be considered in patients with advanced AIDS who present with evidence of acute cholecystitis.