Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
BMJ Case Rep. 2021 Mar 10;14(3):e240509. doi: 10.1136/bcr-2020-240509.
Eosinophilic ascites is a rare type of exudative ascites most commonly caused by eosinophilic gastroenteritis. Here, a 57-year-old man presents with sudden-onset abdominal distension associated with nausea, vomiting and decreased appetite for 10 days. Physical examination revealed significant abdominal distention and fluid wave. Initial labs showed leucocytosis and mild peripheral eosinophilia. Imaging of his abdomen revealed severe ascites, no features of cirrhosis and diffuse inflammatory changes involving the jejunum and ileum. Diagnostic paracentesis showed exudative, ascitic fluid with predominant eosinophilia. Cytology of the ascitic fluid and blind biopsies taken during oesophagogastroduodenoscopy and enteroscopy were both negative for malignancy. The ascites reaccumulated rapidly, requiring five rounds of large-volume paracentesis during hospitalisation. Empiric treatment for suspected eosinophilic gastroenteritis with intravenous steroids improved and stabilised the patient's ascites for discharge. Parasitic workup resulted positively for antibodies on ELISA. On 2-week outpatient follow-up, a course of albendazole resolved all gastrointestinal symptoms.
嗜酸性腹水是一种罕见的渗出性腹水，最常见于嗜酸性胃肠炎。这里，一名 57 岁男性因突发腹胀伴恶心、呕吐和食欲减退 10 天就诊。体格检查显示明显腹胀和液波震颤。初步实验室检查显示白细胞增多和外周血轻度嗜酸性粒细胞增多。腹部影像学检查显示严重腹水，无肝硬化特征和累及空肠和回肠的弥漫性炎症改变。诊断性腹腔穿刺显示渗出性腹水，以嗜酸性粒细胞为主。腹水细胞学检查和胃镜及结肠镜下盲检均未发现恶性肿瘤。腹水迅速积聚，住院期间需要进行五轮大容量腹腔穿刺。疑似嗜酸性胃肠炎的经验性静脉内类固醇治疗改善并稳定了患者的腹水，使其出院。寄生虫检查结果为 ELISA 抗体阳性。在 2 周的门诊随访中，阿苯达唑疗程解决了所有胃肠道症状。
