A man with abdominal fullness

Abstract

A 64-year-old man presented with abdominal fullness and intermittent night fever for 1 month. His medical history included hemodialysis for 1 year and hypertension. He did not drink alcohol and had no history of chronic hepatitis B or hepatitis C virus infection. There was no body weight loss, cough, or bowel habit change. His physical examination revealed abdominal distension and shifting dullness on percussion. Laboratory workup revealed anemia (hemoglobin, 8.4 g/dL) and hypoalbuminemia (albumin, 2.8 g/ dL). The chest radiograph was normal. An abdominal computed tomography with contrast showed ascites, smooth uniform thickening of the peritoneum (arrowhead), omental cakes (arrow; Fig. 1), and soft tissue strands with crowded vascular bundles in the small bowel mesentery (Fig. 2). The ascitic fluid was cloudy yellow; the analysis revealed a white blood cell count of 950 cells/mm with 67% lymphocytes and a total protein level of 4.73 g/dL. Ascitic fluid culture, cytology, cell block, and acid-fast stain yielded negative results.