Infection as a rare cause of portal vein cavernous transformation and obstructive biliopathy.

Cavernous transformation of the portal vein is a rare condition that is often misdiagnosed or diagnosed late due to its insidious onset and nonspecific clinical presentation. It is most often associated with prothrombotic conditions, liver disease, malignancy, or local inflammation. We report a rare case involving a 65‑year‑old woman with HIV infection (CD4 count 96 cells/µL) who developed portal vein cavernous transformation leading to obstructive biliopathy. Cholangioscopy excluded intrinsic mucosal pathology or neoplasm, and additional testing ruled out other hypercoagulable disorders. Following placement of a biliary stent, her cholestatic symptoms resolved and her alkaline phosphatase and bilirubin levels declined. This case highlights HIV as an unusual precipitant of portal vein cavernous transformation and discusses imaging findings, underlying etiologies, and other management options.