Abstract

A 46-year-old man presented to Vancouver General Hospital in September, 2021, with abdominal pain and fever. Physical examination revealed ascites and dependent oedema. Bloodwork showed leukocytosis with 31·5 × 109 cells per L (normal 4–11), creatinine of 191 μmol/L (normal <115), and alkaline phosphatase of 262 U/L (normal <135), with normal transaminases. CT showed hepatomegaly (21·0 cm), splenomegaly (15·5 cm), ascites, bilateral pleural effusions and soft tissue stranding within the omentum and mesentery with mildly enlarged cervical (1·2 cm) and mesenteric (1·3 cm) lymph nodes.

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