Kang Hwa Mi, Oh Tae Hoon, Kang Gun Hi, Joen Tae Joo, Seo Dong Dae, Shin Won Chang, Choi Won Choong, Yang Keun Ho
Departments of Internal Medicine and Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2011 Dec;58(2):111-6. doi: 10.4166/kjg.2011.58.2.111.
Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.
低血清腹水白蛋白梯度（SAAG）的淋巴细胞性腹水主要见于结核性腹膜炎、腹膜癌病和胰腺疾病。然而，盆腔炎（PID）引起的导致弥漫性腹水的全身性腹膜炎鲜有报道。我们报告一例26岁女性患者，其因沙眼衣原体感染被诊断为伴有弥漫性腹水的全身性腹膜炎。妇科检查未发现PID线索，腹水分析显示SAAG低、淋巴细胞计数为主且腺苷脱氨酶水平高。尽管基于这些发现最可能的诊断是结核性腹膜炎，但腹腔镜检查结果与PID一致，宫颈拭子沙眼衣原体感染的聚合酶链反应（PCR）呈阳性。该病例提示，沙眼衣原体腹膜炎应被视为性活跃女性低SAAG和淋巴细胞性腹水的罕见原因，应进行包括腹腔镜检查在内的全面评估。
