We reported a 64-year-old male with intrahepatic cholangiocarcinoma (ICC), whose main manifestations were abdominal pain, fever and multiple hepatic masses. He was once diagnosed with acute cholecystitis and hepatic metastatic carcinoma. After anti-infective therapy, his fever was still difficult to control. The serum level of carbohydrate antigen 199 (CA199) was as high as 3 222U/ml, and ultimately, he was diagnosed with ICC and neoplasm necrosis accompanied with infection and acute cholecystitis after liver puncture biopsy. The patient was given palliative and symptomatic treatment, and died in 2 months later. Based on literature and our clinical experience, it is difficult to diagnose ICC at early period. It has high malignancy, may be accompanied with necrosis and infection sometimes, has few opportunities for radical excision, and thus, poor prognosis finally. In order to facilitate the early diagnosis and treatment of this disease, geriatric gastroenterology physicians should be familiar with the characteristics of ICC, and pay more attention to health examination.