Introduction: Acalculous cholecystitis is a rare condition primarily affecting critically ill and comorbid patients. Q fever, caused by Coxiella burnetii, is an uncommon zoonotic infection typically associated with exposure to livestock including cattle and sheep. Presentation with acalculous cholecystitis is rare. Case Report: A 50-year-old female presented to a rural New South Wales Hospital with subjective fevers, malaise and right upper quadrant abdominal pain. She had daily exposure to farm animals including sheep. She was tachycardic and hypotensive on arrival. Abdominal exam revealed right upper quadrant tenderness. Liver function tests and inflammatory markers were normal. CT imaging revealed gallbladder wall thickening and stranding suspicious for cholecystitis. Ultrasound confirmed a thickened and hyperaemic gallbladder without cholelithiasis consistent with acalculous cholecystitis. Q fever serology returned positive with elevated phase II IgG and IgM titres suggestive of acute infection. She was treated with empirical intravenous ceftriaxone and gentamicin, followed by doxycycline, with resolution of her symptoms. Follow-up MRCP demonstrated resolution of these imaging findings. Discussion: Coxiella burnetii is an important cause of zoonotic infection in rural Australia. Though rare, occupational animal exposure provides opportunities for infection. Symptoms of infection are variable, typically presenting as a severe flu-like illness. Presentation with symptoms and imaging consistent with acalculous cholecystitis warrants investigation of Q fever in the appropriate clinical context. Early recognition may allow for conservative therapy, avoiding unnecessary operative management. Conclusion: Coxiella burnetii is a rare but important cause of acalculous cholecystitis in the rural Australian context. Serological testing should be considered in the appropriate clinical context to allow timely diagnosis and conservative management.