• Wang-Da Liu, Chih-Ning Cheng, Ya-Ting Lin, Ching-Hua Kuo, Shu-Yuan Ho, and Chien-Ching Hung.
• Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
• Medicine (Baltimore). 2021 Jul 16; 100 (28): e26653e26653.

RationaleAcute retroviral syndrome is the symptomatic presentation of acute human immunodeficiency virus (HIV) infection, which often manifests as a self-limited infectious mononucleosis-like syndrome and occurs 2 to 6 weeks after exposure to HIV. Atypical manifestations including hepatitis, meningitis, or hemophagocytic lymphohistiocytosis have been reported. However, manifestations of acute acalculous cholecystitis during acute HIV infection are rarely reported.Patient ConcernsA 30-year-old man with nausea and loose stools, followed by fever and abdominal pain at the right upper quadrant for 10 days.DiagnosisAcute retroviral syndrome, complicated with acute acalculous cholecystitis.InterventionsPercutaneous transhepatic gallbladder drainage was performed and treatment with co-formulated bictegravir/emtricitabine/tenofovir alafenamide was initiated upon HIV diagnosis.OutcomesThe patient's symptoms improved after the drainage. The levels of liver enzyme including aspartate transaminase alanine aminotransferase decreased to a level within normal limits 1 month after initiation of antiretroviral therapy.ConclusionAcalculous cholecystitis in combination with acute hepatitis could be manifestations of acute HIV infection. For individuals at risk of acquiring HIV infection who present with manifestations of acute acalculous cholecystitis, HIV testing should be considered.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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