Korean J Med.  2016 Oct;91(2):179-184. 10.3904/kjm.2016.91.2.179.

Coexistence of Myxedema Ascites and Tuberculous Peritonitis: a Case Report and Literature Review

• Lee DH
• Kuk KW
• Kim SB
• Yoo WS

• KMID: 2357435
• DOI: http://doi.org/10.3904/kjm.2016.91.2.179

Abstract

Some patients have ascites without having liver disease, so it is important to analyze the cause of these ascites. Tuberculous peritonitis is an infectious disease characterized by lymphocyte-dominant exudative ascites. In contrast, myxedema ascites is a very rare disease characterized by a high serum/ascites albumin gradient (SAAG) with hypothyroidism. We herein report a case involving a 48-year-old woman with both diseases simultaneously. She was hospitalized because of massive ascites, generalized edema, and a puffy face. Hypothyroidism was confirmed by thyroid function tests. Her ascitic fluid had a high SAAG; no other specific findings were identified by cytology, culture, or computed tomography. Three months after initiating drug therapy for the hypothyroidism, the patient's systemic edema improved but the ascites recurred. Accordingly, diagnostic laparoscopy was performed, and tuberculous peritonitis was confirmed. As seen in this case, when myxedema ascites is associated with tuberculous peritonitis, an accurate diagnosis may be challenging.

Keyword

Ascites; Hypothyroidism; Myxedema; Peritonitis, Tuberculous

MeSH Terms

Ascites*
Ascitic Fluid
Communicable Diseases
Diagnosis
Drug Therapy
Edema
Female
Humans
Hypothyroidism
Laparoscopy
Liver Diseases
Middle Aged
Myxedema*
Peritonitis, Tuberculous*
Rare Diseases
Thyroid Function Tests