A 33-year-old woman came to the OPD with a 14 days history of epigastric pain, vomiting, diarrhea, and abdominal enlargement. She had had a non-complicated pregnancy and delivered seven weeks early. The patient dismissed recent travel, new medication, atopy, allergies, diet modifications, or ill contact before the symptoms.
Examination
Physical examination showed abdominal distention and shifting dullness. The gynecological examination was normal. Laboratory evaluation showed a raised white blood cell count of 14,900 L with 41.7% eosinophils (6.200 L), PCR 1.3 mg/dL (normal < 1.0 mg/dL), hypoproteinemia (5.7 g/dL), hypoalbuminemia (3.0 g/dL) and an increased IgE level (240 KUI/L). Hemoglobin, red blood cell count, coagulation studies, serum electrolytes, creatinine, alpha-1 antitrypsin, immunoglobulins, thyroid, and liver function tests were within the normal range. Stool ova and parasites, stool, urine and blood cultures, and Toxicological serology were all negative. On abdominal and transvaginal USG, there was a large amount of abdominal and pelvic ascites. Diagnostic paracentesis was performed and revealed an exudative type of ascites with protein level 4.1 g/dL, albumin 2.0 g/dL, and raised leukocytes (3600L), but unfortunately, the cellular differential count was not made. Bacteriological culture and adenosine deaminase were negative. CT scan showed pyloric antrum, duodenum, and jejunum wall thickening and large volume ascites. Esophagogastroduodenoscopy revealed pyloric enlarged folds, and colonoscopy was unremarkable. Duodenal biopsy showed focal fold shortening with eosinophilic infiltration in lamina propria.
Like
Answers
Save
Share