An uncommon organism in ascitic fluid.

Abstract

what’s your diagnosis?An uncommon organism in ascitic fluid Vishal Khurana, Jayanta Dasgupta, Keya Basu, and Sukanta Ray Vishal Khurana Search for more papers by this author , Jayanta Dasgupta Search for more papers by this author , Keya Basu Search for more papers by this author , and Sukanta Ray Search for more papers by this author Published Online:7 Aug 2014https://doi.org/10.5144/0256-4947.2014.358SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionA 32-year-old nonalcoholic, nondiabetic male, who had a history of mild acute biliary pancreatitis one year back and who subsequently underwent laparoscopic cholecystectomy, presented with abdominal pain and abdominal distension for almost four months. He denied any history of trauma, alcohol use, pancreatogenic drug intake, fever, or jaundice. At presentation he had pallor, tachycardia, and ascites; rest of the systemic examination was unremarkable. The investigation revealed hemoglobin 10 mg/dL (normocytic-normochromic), total leukoleukocyte count 7500/mm3 (eosinophil 3%), albumin 2.5 g/dL (reference value 3.5-5 g/dL), serum amylase 1356 U/L (reference value 30-118 U/L), and serum lipase 785 U/L (reference value 13-60 U/L). Results of serum calcium, fasting lipid profile, renal function test, and liver function test were within the normal range. The cross-sectional imaging revealed collections in subdiaphragmatic and pancreatic head and tail regions and dilated (6 mm) pancreatic duct (Figure 1). Ascitic fluid analysis revealed hemorrhagic fluid with leukocyte count of 550/mm3 (neutrophil 80%, eosinophil 5%, lymphocyte 15%), red cell count of 50000/mm3, total protein 2.2 g/dL, albumin 1.5 g/dL, adenosine deaminase level 13.3 IU/L (cut-off value 40 IU/L), and amylase of 27120 U/L. Apart from it, a worm was also seen in ascitic fluid (Figure 2).Figure 1 Axial section of MRI abdomen (T1WI) at the level of pancreatic body showing collection in the right and left subdiaphragmatic regions and the pancreatic head region. The main pancreatic duct is also dilated in the body of pancreas.Download FigureFigure 2 Hematoxylin and eosin–stained slide (40×, magnified to 150%) of ascitic fluid showinga microfiliaria with a sheath having two nuclei at the tail region, which is suggestive of microfilaria of Brugia malayi.Download Figure Previous article Next article FiguresReferencesRelatedDetails Volume 34, Issue 4July-August 2014 Metrics History Published online7 August 2014 InformationCopyright © 2014, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download