Cyclospora cayetanensis can occasionally infect the biliary tract. This can result in symptoms that may be misinterpreted as cholelithiasis.
Clinical features:
(1) The patient has usually immunocompromised, often with AIDS.
(2) The patient has right upper quadrant pain.
(3) The serum alkaline phosphatase may be elevated.
(4) Gallstones may or may not be present.
(5) Symptoms clear after Bactrim (TMP-SMX) therapy.
The diagnois should be considered in an immunosuppressed patient with acalculous cholecystitis, especially if the patient lives, has traveled to, or recently eaten food from an endemic country.
If the gallbladder is removed then organisms can be demonstrated but additional sections with special stains may be needed.
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