During the course of acute viral hepatitis, some functional and anatomical changes to the gallbladder can occur. Acute acalculous cholecystitis (ACC) is a rare complication of acute hepatitis B virus infection; only few cases are reported as ACC associated with acute hepatitis B virus infection. ACC cases are self-limiting, while other limited cases can progress to a gangrenous state, perforation, and even death. We present a 27-year-old female case diagnosed to have acute acalculous cholecystitis and associated with acute hepatitis B virus infection, and she recovered within one week of her presentation without complication or surgical intervention. 1. Background During the course of acute viral hepatitis, some functional and anatomical changes to the gallbladder can occur. Acute acalculous cholecystitis (ACC) is a rare complication of acute viral hepatitis. Some of these cases are self-limiting, while other limited cases can progress to a gangrenous state, perforation, and even death. The definition of ACC is the inflammation of gallbladder wall in the absence of calculous or sludge; the incidence of ACC is about 5–15% of all cases of cholecystitis, of which 47% occur after surgical procedure, and the other percentage due to prolonged immobilization, starvation for a long time, and sepsis [1–3]. The pathogenesis of acalculous cholecystitis occurred because of the detergent effect of bile on the epithelium, ischemic injury of the gallbladder epithelium; immune complex deposits in the vessel wall of gallbladder may cause necrotizing vasculitis as an extrahepatic complication of chronic hepatitis B virus (HBV) infection [4]. Some cases of HAV reported that the pathogenesis of ACC is due to direct invasion of the virus to gallbladder wall [5, 6]. During the course of acute hepatitis, gallbladder wall oedema and slowing of bile clearance which may lead to the formation of bile sludge and thickening of the gallbladder wall [7–9]. Limited number of cases of ACC were reported to be associated with acute viral hepatitis A infection [5, 10–13] and only one case reported with hepatitis B infection [14]. ACC associated with acute viral hepatitis can present in different conditions; most cases are self-limiting, while limited number of cases progress to a gangrenous state, gallbladder perforation, and sometimes death [5, 12, 13]. We would like to present here a second reported case of ACC associated with an acute hepatitis B virus infection [14]. 2. Case Report This is a 27-year-old female patient, who came to A&E with 9-day history of epigastric pain, nausea,
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