Crossman Lauren, Ronald Funk Christopher, Kandiah Sheetal, Hemrajani Reena
Emory University School of Medicine, Atlanta, GA, USA.
Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Case Rep Nephrol. 2023 Apr 20;2023:4240423. doi: 10.1155/2023/4240423. eCollection 2023.
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 . 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.
一名来自结核病流行地区的中年男性移民，有终末期肾病病史，因常规血液透析和腹部肿胀前往急诊室。他因建议每日透析以改善容量超负荷而入住内科，容量超负荷归因于肾源性腹水。他被发现有一些与全身性疾病相关的表现，包括发热、盗汗、高钙血症、淋巴结病、网膜增厚、血清腹水白蛋白梯度小于1.1克/分升的腹水以及渗出性胸腔积液。我们高度怀疑是血液系统恶性肿瘤还是播散性感染。在住院期间，要获得对我们主要怀疑诊断——播散性结核病的组织学和细菌学确认存在许多诊断挑战。最终，通过颈部淋巴结肉芽肿性炎症的组织学证据和痰培养阳性确诊为结核感染。这个病例强调了每个出现新发腹水的患者都必须接受诊断性腹腔穿刺术的必要性。肾源性腹水是一种罕见的综合征，在容量超负荷状态下有可能发生，但它是一种排除性诊断，应由渗出性血清腹水白蛋白梯度及无其他病因证据来支持。
