A 67-year-old woman presented with lower abdominal pain, diarrhea, nausea, vomiting and fatigue. Computed tomography was suggestive of cholecystitis, but neither ultrasound nor magnetic resonance cholangiopancreatography found evidence of cholecystitis or biliary ductal dilatation. The patient was started on piperacillin-tazobactam, and blood cultures revealed gram-negative-rod bacteremia. Laparoscopic cholecystectomy was performed and bile cultures grew susceptible to ciprofloxacin, which was identical to the speciation of her positive blood cultures. In addition, pathology revealed adenomyomatous hyperplasia of the gallbladder and chronic cholecystitis. Unlike other cases of cholecystitis, our patient had no significant risk factors for the infection-no history of immunosuppression, diabetes mellitus, nor underlying malignancy. We discuss the current knowledge of infection in the setting of chronic cholecystitis and adenomyomatous hyperplasia.