Article Text
PDF
Summary
The authors present a case of a 51-year-old woman with clinical diagnosis of mixed connective tissue disease and overlap systemic lupus erythematosus features, with a 6-month history of progressive painless abdominal distension. On examination, evident signs of ascites were present. Both the abdominal-pelvic ultrasound and CT scan confirmed a large amount of ascites. A diagnostic paracentesis was performed, which revealed typical features of chylous ascites (CA). An extensive diagnostic work-up led by a multidisciplinary team was performed, excluding malignancy, cirrhosis, infectious, as well as cardiac and primary lymphatic causes. The patient was kept under surveillance, with dietary therapy and periodic ascitic drainages. The hypothesis of an autoimmune cause for CA was considered by exclusion. Rituximab therapy was initiated and an excellent response was achieved, with reduction of the rate of accumulation of CA and an increase in quality of life of the patient.
- connective tissue disease
- biological agents
- gastrointestinal system
Statistics from Altmetric.com
Footnotes
Contributors AD did the clinical process review, from the initial symptoms to the final diagnosis, and also elaborated the literature review. GB helped AD in the review process. EV is the assistant physician of oncology who led the differential diagnostic process, providing essential clinical contribution for the exclusion of a malignant cause for chylous ascites. FdG is the assistant physician of rheumatology responsible for the final diagnosis and therapeutic decision of initiating rituximab therapy. He also supervised the report construction from the beginning.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.