Diagnostic Challenge in a Patient Presenting with Ascites and Hypergammaglobulinemia.

Autor: Mustika S; Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia., Pratama MZ; Gastroenterohepatology Division, Department of Internal Medicine, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia., Lesmana CRA; Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
Jazyk: angličtina
Zdroj: Case reports in gastroenterology [Case Rep Gastroenterol] 2021 Sep 21; Vol. 15 (3), pp. 810-818. Date of Electronic Publication: 2021 Sep 21 (Print Publication: 2021).
DOI: 10.1159/000518384
Abstrakt: Ascites is defined as the accumulation of intra-peritoneal fluid that can be caused by several diseases. We described a 47-year-old female presenting with low serum-ascites albumin gradient (SAAG) and a markedly high level of serum globulin. Serum protein electrophoresis revealed an M spike in the gamma region. Other laboratory results showed a marked increase in aspartate aminotransferase and alanine aminotransferase and predominantly conjugated hyperbilirubinemia without a sign of dilatation of bile ducts from abdominal ultrasonography examination. Furthermore, the follow-up showed a positive result for the anti-nuclear antibody test. The patient was assessed with autoimmune hepatitis, and the cause of ascites was suggested from portal hypertension although the level of SAAG was low. The ascites condition got improved after salt restriction, diuretics treatment, and abdominal paracentesis. However, the patient passed away because of the intracranial hemorrhage as a result of prolonged INR and APTT due to liver failure.
Competing Interests: The authors declare that there are no conflicts of interest to disclose.
(Copyright © 2021 by S. Karger AG, Basel.)
Databáze: MEDLINE
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