Autoimmune Ascites Responding to Mycophenolate Mofetil

A Case Report

Douglas Simonetto, Hala Fatima, Folkert Zijlstra, Michael K. Zijlstra

Research output: Contribution to journalArticle

Abstract

Ascites is an abnormal accumulation of fluid within the peritoneal cavity. The most common cause of ascites in the United States population is portal hypertension secondary to cirrhosis, accounting for about 80% of the cases. Other etiologies include malignancy, heart failure, tuberculosis, and pancreatic disease. After an extensive literature review, it is to our best knowledge that there have been no cases reported on autoimmune ascites. We present an interesting case of ascites in a 67-year-old Caucasian male with symptoms of recurrent abdominal distention and significant weight gain, refractory to standard therapies. An extensive 3-year long workup was only significant for serum-ascites albumin gradient > 1.1 g/dL, ascitic fluid protein of 3.0 g/dL, and peritoneal biopsies showing minor inflammatory changes. Both common and rare causes of ascites were ruled out. Empiric treatment with mycophenolate mofetil (CellCept) resulted in resolution of symptoms with no need for a repeat paracentesis for > 2 years, suggesting the diagnosis of autoimmune ascites.

Original languageEnglish (US)
Pages (from-to)207-216
Number of pages10
JournalCase Reports in Gastroenterology
DOIs
StateAccepted/In press - May 31 2018

Fingerprint

Mycophenolic Acid
Ascites
Paracentesis
Pancreatic Diseases
Ascitic Fluid
Peritoneal Cavity
Portal Hypertension
Serum Albumin
Weight Gain
Tuberculosis
Fibrosis
Heart Failure
Biopsy
Therapeutics

Keywords

  • Ascites
  • Autoimmune disease
  • Mycophenolate mofetil

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Autoimmune Ascites Responding to Mycophenolate Mofetil : A Case Report. / Simonetto, Douglas; Fatima, Hala; Zijlstra, Folkert; Zijlstra, Michael K.

In: Case Reports in Gastroenterology, 31.05.2018, p. 207-216.

Research output: Contribution to journalArticle

Simonetto, Douglas ; Fatima, Hala ; Zijlstra, Folkert ; Zijlstra, Michael K. / Autoimmune Ascites Responding to Mycophenolate Mofetil : A Case Report. In: Case Reports in Gastroenterology. 2018 ; pp. 207-216.
@article{24e3f8689e7345cf9abb7081de9c8cff,
title = "Autoimmune Ascites Responding to Mycophenolate Mofetil: A Case Report",
abstract = "Ascites is an abnormal accumulation of fluid within the peritoneal cavity. The most common cause of ascites in the United States population is portal hypertension secondary to cirrhosis, accounting for about 80{\%} of the cases. Other etiologies include malignancy, heart failure, tuberculosis, and pancreatic disease. After an extensive literature review, it is to our best knowledge that there have been no cases reported on autoimmune ascites. We present an interesting case of ascites in a 67-year-old Caucasian male with symptoms of recurrent abdominal distention and significant weight gain, refractory to standard therapies. An extensive 3-year long workup was only significant for serum-ascites albumin gradient > 1.1 g/dL, ascitic fluid protein of 3.0 g/dL, and peritoneal biopsies showing minor inflammatory changes. Both common and rare causes of ascites were ruled out. Empiric treatment with mycophenolate mofetil (CellCept) resulted in resolution of symptoms with no need for a repeat paracentesis for > 2 years, suggesting the diagnosis of autoimmune ascites.",
keywords = "Ascites, Autoimmune disease, Mycophenolate mofetil",
author = "Douglas Simonetto and Hala Fatima and Folkert Zijlstra and Zijlstra, {Michael K.}",
year = "2018",
month = "5",
day = "31",
doi = "10.1159/000488975",
language = "English (US)",
pages = "207--216",
journal = "Case Reports in Gastroenterology",
issn = "1662-0631",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Autoimmune Ascites Responding to Mycophenolate Mofetil

T2 - A Case Report

AU - Simonetto, Douglas

AU - Fatima, Hala

AU - Zijlstra, Folkert

AU - Zijlstra, Michael K.

PY - 2018/5/31

Y1 - 2018/5/31

N2 - Ascites is an abnormal accumulation of fluid within the peritoneal cavity. The most common cause of ascites in the United States population is portal hypertension secondary to cirrhosis, accounting for about 80% of the cases. Other etiologies include malignancy, heart failure, tuberculosis, and pancreatic disease. After an extensive literature review, it is to our best knowledge that there have been no cases reported on autoimmune ascites. We present an interesting case of ascites in a 67-year-old Caucasian male with symptoms of recurrent abdominal distention and significant weight gain, refractory to standard therapies. An extensive 3-year long workup was only significant for serum-ascites albumin gradient > 1.1 g/dL, ascitic fluid protein of 3.0 g/dL, and peritoneal biopsies showing minor inflammatory changes. Both common and rare causes of ascites were ruled out. Empiric treatment with mycophenolate mofetil (CellCept) resulted in resolution of symptoms with no need for a repeat paracentesis for > 2 years, suggesting the diagnosis of autoimmune ascites.

AB - Ascites is an abnormal accumulation of fluid within the peritoneal cavity. The most common cause of ascites in the United States population is portal hypertension secondary to cirrhosis, accounting for about 80% of the cases. Other etiologies include malignancy, heart failure, tuberculosis, and pancreatic disease. After an extensive literature review, it is to our best knowledge that there have been no cases reported on autoimmune ascites. We present an interesting case of ascites in a 67-year-old Caucasian male with symptoms of recurrent abdominal distention and significant weight gain, refractory to standard therapies. An extensive 3-year long workup was only significant for serum-ascites albumin gradient > 1.1 g/dL, ascitic fluid protein of 3.0 g/dL, and peritoneal biopsies showing minor inflammatory changes. Both common and rare causes of ascites were ruled out. Empiric treatment with mycophenolate mofetil (CellCept) resulted in resolution of symptoms with no need for a repeat paracentesis for > 2 years, suggesting the diagnosis of autoimmune ascites.

KW - Ascites

KW - Autoimmune disease

KW - Mycophenolate mofetil

UR - http://www.scopus.com/inward/record.url?scp=85047959156&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047959156&partnerID=8YFLogxK

U2 - 10.1159/000488975

DO - 10.1159/000488975

M3 - Article

SP - 207

EP - 216

JO - Case Reports in Gastroenterology

JF - Case Reports in Gastroenterology

SN - 1662-0631

ER -