Patient 42 yo, labor of the load of bread, one month ago complaint by periumbilical pain crisis.durring 1-2 minutes, no fever no diarrhea, more and more frequent.
Ultrasound abdomen first time detected free fluid ascitis in large amount of volume but unknown origine (see ultrasound images).
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Gastroendoscopy showed gastritis with negative HP test,
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MSCT no CE also made sure this liver no cirrhosis and ascitis unknown origine.
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Blood test report = WBC rising.
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What is your diagnosis for the case and what do you do next ?
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Ultrasound guided punction of ascitis which was removed the yellowish clear fluid and biochemistry and cytology analysis.
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RECENTLY LAB REPORT of BLOOD TEST from THIS PATIENT.
Ultrasound abdomen first time detected free fluid ascitis in large amount of volume but unknown origine (see ultrasound images).
Gastroendoscopy showed gastritis with negative HP test,
MSCT no CE also made sure this liver no cirrhosis and ascitis unknown origine.
.jpg)
.jpg)
Blood test report = WBC rising.
What is your diagnosis for the case and what do you do next ?
Ultrasound guided punction of ascitis which was removed the yellowish clear fluid and biochemistry and cytology analysis.
RECENTLY LAB REPORT of BLOOD TEST from THIS PATIENT.
DISCUSSION:
This case was represented unknown ascitis at first time by ultrasound and CT scan, and blood test report was eosinophil rising too much, 43%, that many doctors were looking for a parasite infected cause.
But, ascitis analysis was transudate fluid and hypoalbumine, while CA125 was very high, of 1380 UI/mL in the male patient. So it was difficult to explain that.
Cytology of ascitis fluid showed that many white blood cells of eosinophil in one staining microscopic champ.
Second report of blood test today ruled out parasite infection, but IgE very high, of 1168 UI/mL, that suggested an eosinophylic gastroenteritis.
For review and make sure this diagnosis, an other ultrasound scanning of abdomen perfomed to detect thickening of intestine wall. And cytology smear of ascitis fluid was more eosinophil cells.
A course of corticotherapy was started today. Wait for clinical response.