Chlamydia: A Rare Cause of Ascites

Abstract

Chlamydia is the most common sexually transmitted infection in the United States and the rate of new infections is on the rise. With the increased prevalence of this infection, clinicians will see more unusual presentations of this disease. Chlamydia can cause an array of symptoms, ranging from vaginal discharge to Fitz-Hugh-Curtis syndrome, sometimes making it difficult to diagnose. Here we present a case of a 26-year-old female who recently underwent uncomplicated vaginal delivery and cholecystectomy with new onset ascites due to chlamydia infection. Gynecologic exam was unrevealing without evidence of cervical motion tenderness. On CT imaging of the abdomen and pelvis the patient was found to have diffuse peritoneal enhancement, but her abdominal imaging was otherwise unremarkable. Ascitic fluid revealed a serum-ascites albumin gradient of 0.7, with 6,123 nucleated cells, of which, 76% were lymphocytes. Further analysis of ascitic fluid failed to grow aerobic or anaerobic bacteria on cultures, did not reveal malignant cells and was negative for Mycobacterium Tuberculosis DNA. Ascitic fluid was positive for chlamydia on nucleic acid amplification test (NAAT) which was corroborated by the presence of chlamydial nucleic acid in both urine and throat specimens. Ascites from pelvic inflammatory disease secondary to chlamydia is a rare cause of ascites but should be suspected in the correct clinical context. Heightened awareness of this condition will help prevent unnecessary diagnostic testing and allow for prompt diagnosis and initiation of appropriate treatment.