BACKGROUND: Spontaneous bacterial peritonitis is frequently described in cirrhotic patients who develop infected ascitic fluid. However, ascites can be cardiac in origin. The phenomenon of spontaneous bacterial peritonitis in cardiac ascites is an extremely rare but deadly occurrence.

CASE REPORT: Here we present a unique case of a patient who was admitted for advanced cardiorenal syndrome in the setting of a viral colitis that likely promoted a bacterial translocation resulting in spontaneous bacterial peritonitis.

CONCLUSIONS: This case tends to shed light on a few quintessential points for clinicians to be aware of, including the potential intersection between the microbiota and metabolic effects of congestive heart failure and the necessity to lower the diagnostic threshold for spontaneous bacterial peritonitis cardiac ascites in patient’s presenting for a congestive heart failure exacerbation.

Keywords: Ascites, Bacterial Translocation