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Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites
A middle-aged immigrant male from a region with endemic tuberculosis who had a history of end-stage kidney disease presented to the emergency room for routine hemodialysis and abdominal swelling. He was admitted to the medicine service for suggested daily dialysis to improve his volume overload, whi...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10139807/ https://www.ncbi.nlm.nih.gov/pubmed/37124145 http://dx.doi.org/10.1155/2023/4240423 |
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author | Crossman, Lauren Ronald Funk, Christopher Kandiah, Sheetal Hemrajani, Reena |
author_facet | Crossman, Lauren Ronald Funk, Christopher Kandiah, Sheetal Hemrajani, Reena |
author_sort | Crossman, Lauren |
collection | PubMed |
description | A middle-aged immigrant male from a region with endemic tuberculosis who had a history of end-stage kidney disease presented to the emergency room for routine hemodialysis and abdominal swelling. He was admitted to the medicine service for suggested daily dialysis to improve his volume overload, which was attributed to nephrogenic ascites. He was found to have several findings concerning for systemic illness, including fevers, night sweats, hypercalcemia, lymphadenopathy, omental thickening, ascitic fluid with a serum ascites albumin gradient of less than 1.1 gm/dL, and exudative pleural effusions. Our suspicion for hematologic malignancy versus disseminated infection was high. During admission, there were many diagnostic challenges in obtaining histologic and bacteriologic confirmation of our leading suspected diagnosis, disseminated tuberculosis. Ultimately, tuberculosis infection was confirmed with histologic evidence of granulomatous inflammation of cervical lymph node and sputum culture positive for Mycobacterium tuberculosis. This case highlights the necessity for every patient presenting with new ascites to undergo diagnostic paracentesis. Nephrogenic ascites is a rare syndrome that is possible in volume overloaded states but is a diagnosis of exclusion that should be supported by an exudative serum ascites albumin gradient and no evidence of an alternate etiology. |
format | Online Article Text |
id | pubmed-10139807 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-101398072023-04-28 Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites Crossman, Lauren Ronald Funk, Christopher Kandiah, Sheetal Hemrajani, Reena Case Rep Nephrol Case Report A middle-aged immigrant male from a region with endemic tuberculosis who had a history of end-stage kidney disease presented to the emergency room for routine hemodialysis and abdominal swelling. He was admitted to the medicine service for suggested daily dialysis to improve his volume overload, which was attributed to nephrogenic ascites. He was found to have several findings concerning for systemic illness, including fevers, night sweats, hypercalcemia, lymphadenopathy, omental thickening, ascitic fluid with a serum ascites albumin gradient of less than 1.1 gm/dL, and exudative pleural effusions. Our suspicion for hematologic malignancy versus disseminated infection was high. During admission, there were many diagnostic challenges in obtaining histologic and bacteriologic confirmation of our leading suspected diagnosis, disseminated tuberculosis. Ultimately, tuberculosis infection was confirmed with histologic evidence of granulomatous inflammation of cervical lymph node and sputum culture positive for Mycobacterium tuberculosis. This case highlights the necessity for every patient presenting with new ascites to undergo diagnostic paracentesis. Nephrogenic ascites is a rare syndrome that is possible in volume overloaded states but is a diagnosis of exclusion that should be supported by an exudative serum ascites albumin gradient and no evidence of an alternate etiology. Hindawi 2023-04-20 /pmc/articles/PMC10139807/ /pubmed/37124145 http://dx.doi.org/10.1155/2023/4240423 Text en Copyright © 2023 Lauren Crossman et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Crossman, Lauren Ronald Funk, Christopher Kandiah, Sheetal Hemrajani, Reena Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites |
title | Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites |
title_full | Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites |
title_fullStr | Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites |
title_full_unstemmed | Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites |
title_short | Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites |
title_sort | disseminated peritoneal tuberculosis initially misdiagnosed as nephrogenic ascites |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10139807/ https://www.ncbi.nlm.nih.gov/pubmed/37124145 http://dx.doi.org/10.1155/2023/4240423 |
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