AIDS cholangiopathy is suspected when patients with advanced human immunodeficiency virus (HIV) infection present with right upper quadrant abdominal pain, diarrhoea, jaundice, and fever [3].
All these features were suggestive of AIDS cholangiopathy (Figure 1(a)).
We describe here a patient with AIDS cholangiopathy due to CMV occurring within 2 months of switching to effective HAART.
Three reports of CMV-induced duodenal papillitis in AIDS patients and 32 cases of CMV-induced AIDS cholangiopathy have been described till date.
AIDS cholangiopathy secondary to IRIS has been reported only once, presented as paradoxical IRIS secondary to Crytposporidium [7].
The therapy of AIDS cholangiopathy is primarily endoscopic, and the approach varies with the anatomic abnormality.
There is a possibility that our patient may have had a CMV OI presenting as AIDS cholangiopathy. However, our patient had CD4 count of 109/[micro]L, and most cases of CMV AIDS cholangiopathy have been described in severely immunocompromised hosts with CD4 <100/[micro]L.
In conclusion, we report the first case of AIDS cholangiopathy due to CMV presenting as unmasking IRIS.