CASE 448 : FEVER and ASCITES, Dr PHAN THANH HẢI, Dr NGUYỄN PHÚ HỮU, MEDIC MEDICAL CENTER, HCMC,VIETNAM

Woman 40 yo with one week  fever,  abdomen pain  and distention..

Clinical examination ruled out  surgical needs , chest  X-ray is normal.

• Ultrasound of abdomen = liver, biliary system,  kidney are normal, huge amount of  ascites volume with cloudy fluid  (us1 , us2, us3 pelvis  us4 ovary).

CT scan of abdomen  =  No tumor detection [ ct1,frontal view, ct2, ct3  cross section].

Blood tests =  WBC  15k with 13,3 k neutro, CRP= 25.9,  amylase, CEA , CA 125  are  normal level.  But Widal test is  positive th;1/320

Ascites punction= yellow  clear,   analysis =  ADA= 19.5 ng/mL,  CA125 :396 UI/mL, CEA: 0,8UI,  albumine =3.9 mg/mL

After 2 weeks treated with antibiotics;   response is good,   no fever  but ascites  is  distention after  aspiration  many times.

Summary=   Fever with typhoid  but ascites  still  persistent after one month.

Discussion :   Fever and   Widal test positive  is  Typhoid fever, treated response with antibiotics, but ascites  is still  progressing, so that  is not feature of Typhoid fever (one  expert of infectious disease says). Ascites analysis  can rule out  pancreatitis,  tuberculosis and  cirrhosis.  With CT , ultrasound  don't  detect any tumor intra abdomen. Then the short  way for diagnosis is  laparoendoscopy  for biopsy.

Laparoendoscopy  detected  multiple white spots intra parietal peritoneum,  most common in diaphragma area  (see foto)  suspected peritoneal carcinomatosis.

Microscopic result is malignant mesothelioma.

Reference:

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