06 April 2015 : Case report
Untangling the Etiology of Ascites
Unusual clinical course, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)Michael Lopez-MolinaADEF, Ashok V. ShianiADEF, Kellee L. OllerADEF
Am J Case Rep 2015; 16:202-205
BACKGROUND: Amyloidosis is a systemic disease known to affect a vast range of organs, including the liver, heart, and kidney. When infiltrating the liver, amyloidosis typically does not present with cirrhosis. Typical presentation includes hepatomegaly with some mild laboratory abnormalities.
CASE REPORT: A 72-year-old man presented with a 2-week history of worsening abdominal, scrotal, and extremity swelling. He endorsed melanotic stools and intermittent dizziness with a 10-pound weight gain. Vitals revealed a blood pressure of 82/57 mmHg and a pulse of 83 beats/min with positive orthostatic changes. Mild bibasilar crackles were noted. His abdomen was moderately distended with a fluid wave present, but no hepatosplenomegaly was noted. He displayed anasarca with significant extremity and scrotal edema, but no jaundice, telangiectasias, or other stigmata of chronic liver disease were present. Liver function tests demonstrated a total bilirubin of 1.5 mg/dL (normal value: 0.2–1.2 mg/dL), AST 111 IU/L (normal value 5–34 IU/L), ALT 51 IU/L (normal value 5–55 IU/L), and GGT 583 U/L (12–64 U/L). Alkaline phosphatase was 645 U/L (40–150 U/L). Analysis of peritoneal fluid was consistent with portal hypertension due to liver disease. Given an atypical presentation of cirrhosis with unclear etiology, a biopsy was performed and revealed amyloid deposition.
CONCLUSIONS: Liver disease can be due to various etiologies, many of which can present ambiguously. Although the most typical etiologies have been well defined, we present a case of an atypical presentation of hepatic amyloidosis discovered in a patient with ascites and without typical hepatomegaly.
Keywords: Amyloidosis - diagnosis, Ascites - etiology, Fatal Outcome, Liver Diseases - diagnosis
21 March 2023 : Case reportKidney Transplantation from a Deceased Donor with COVID-19 Ad26.COV2-S Vaccine-Induced Thrombotic Thrombocy...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938730
21 March 2023 : Case reportClassical Presentation of Disseminated Blastomycosis in a 44-Year-Old Healthy Man 3 Months After Diagnosis ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938659
22 February 2023 : Case reportA 30-Year-Old Woman with an 8-Week History of Anxiety, Depression, Insomnia, and Mild Cognitive Impairment ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938732
22 February 2023 : Case reportMultidrug-Resistant Kocuria rosea and Methicillin-Resistant Staphylococcus aureus Co-Infection in a Nigeria...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938761
23 Mar 2023 : Case reportCase Series of Genetically Confirmed Index Cases of Familial Hypercholesterolemia in Primary Care
Am J Case Rep In Press; DOI: 10.12659/AJCR.939489
22 Mar 2023 : Case reportLaparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis and a Double Superior Vena Cava
Am J Case Rep In Press; DOI: 10.12659/AJCR.938774
22 Mar 2023 : Case reportRare Case of Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome with Monoclonal Gammo...
Am J Case Rep In Press; DOI: 10.12659/AJCR.939650
22 Mar 2023 : Case reportOral and Intranasal Ketamine Use in Treatment-Resistant Catatonia: A Clinical Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939530
Most Viewed Current Articles
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
07 Dec 2021 : Case reportEdwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...
Am J Case Rep 2021; 22:e934347