ACALCULOUS CHOLECYSTITIS ASSOCIATED WITH CYTOMEGALOVIRUS AND SCLEROSING CHOLANGITIS IN A PATIENT WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Intra- and extrahepatic bile-duct strictures, papillary stenosis and a calculous cholecystitis have all been described in ill patients with a cquired immunodeficiency syndrome (AIDS). Acalculous cholecystitis ass ociated with cytomegalovirus (CMV), Cryptosporidium or Campylobacter o rganisms has typically been described in critically ill or moribund pa tients. The authors report a case of acute acalculous CMV cholecystiti s in a 28-year-old man who presented with abdominal pain. The patient was infected with the human immunodeficiency virus (HIV) but was ambul atory and had had no AIDS-defining illness. The patient did not have a ny well-recognized risk factors for acalculous cholecystitis, showing that this entity can occur in relatively healthy HIV-infected patients as well as in the terminal stages of AIDS. The diagnosis should be co nsidered when such a patient presents with abdominal pain. Furthermore , this patient had sclerosing cholangitis of the intra- and extrahepat ic bile ducts as well as papillary stenosis. The cause of the acalculo us cholecystitis was presumed to be CMV, but the disease progressed de spite therapy with foscarnet.