Cytomorphology of Mycobacterium avium intracellulare-associated ascites.

Ascites due to Mycobacterium avium intracellulare (MAI) infection is extremely rare and associated with a poor outcome. The cytomorphology of this condition has not been previously reported. We present a unique case of a 45-year-old woman with iatrogenic immunodeficiency who developed MAI-associated chylous ascites. The ascitic fluid cytology showed numerous lymphocytes and foamy histiocytes with abundant intracytoplasmic MAI organisms. The diagnosis was confirmed by tissue biopsy showing MAI mesenteritis. It is important to consider MAI-associated ascites in the differential diagnosis whenever ascitic fluid shows a predominant population of lymphocytes and macrophages, especially in immunocompromised patients.

Chylous ascites: a late complication of intra-abdominal Mycobacterium avium complex immune reconstitution syndrome in HIV-infected patients.

Chylous ascites related to Mycobacterium avium complex (MAC) in HIV-infected patients is rare, with only six cases reported in the English literature. We report a series of six cases from a single institution. During the past six years, chylous ascites was diagnosed in six (35%) of 17 AIDS patients, all of whom had previously been diagnosed with intra-abdominal MAC immune reconstitution syndrome (MAC-IRS). A review of medical records identified no other cases of chylous ascites among HIV-positive patients over the past 13 years (1994-2007), and the incidence was estimated at one in 2248 HIV-positive admissions. The ascitic fluid had a milky appearance and a median triglyceride level of 4.07 mmol/L (range 3.19-29.6 mmol/L) (360 mg/dL, range 282-2620 mg/dL). After a median follow-up of 20 months, five (83%) of six patients survived. Chylous ascites is a late complication of intra-abdominal MAC-IRS, and is usually associated with a favourable prognosis.

Chylothorax and chylous ascites due to Mycobacterium tuberculosis in an AIDS patient whose PCR tested negative.

Mycobacterium tuberculosis as a cause of both chylothorax and chylous ascites is extremely rare. A 46-year-old non-adherent woman with AIDS and pulmonary tuberculosis presented to our clinic with dyspnea, pleuritic chest and abdominal pain. Chest x-ray demonstrated a left pleural effusion. Contrast-enhanced CT showed free abdominal fluid. Thoracentesis revealed a chylothorax, and paracentesis a chylous ascites. AFB staining and PCR for M. tuberculosis (GeneXpert MTB/ RIF Assay) were both negative. Malignant cells cytology also tested negative. Tuberculosis could account for both chylothorax and chylousascites, as she clinically improved when antituberculous drugs were resumed. Even when PCR tested negative, M. tuberculosis should be included in the differential diagnosis because of its therapeutic and prognostic implications. Keywords: Chylothorax, chylous ascites, Mycobacterium tuberculosis, acquired immunodeficiency syndrom, antituberculous drugs.

Spontaneous perforation of the left hepatic duct with acalculous cholecystitis.

Spontaneous rupture of the biliary tree leading to bile peritonitis is rare. We report a boy who developed spontaneous perforation of the left hepatic duct and had acalculous cholecystitis.

Chylous ascites, tuberculosis and HIV/AIDS: a case report.

The case is reported of a 53 year old long distance bus driver who had complained of fever, weight loss, abdominal and leg swelling and had a past history of inadequately treated pulmonary tuberculosis. Physical findings included generalised lymphadenopathy, finger clubbing, pedal oedem and chylous ascites. He tested positive for HIV type 1 and the histology of a lymph node biopsy was compatible with tuberculosis which responded favourably to antituberculous chemotherapy.

Penicillium marneffei chylous ascites in acquired immune deficiency syndrome: a case report.

Penicillium marneffei (P. marneffei) infection usually occurs with skin, bone marrow, lung or hepatic involvement. However, no cases of P. marneffei infection with chylous ascites have been reported thus far. In this report, we describe the first case of acquired immune deficiency syndrome (AIDS) which has been complicated by a P. marneffei infection causing chylous ascites. We describe the details of the case, with an emphasis on treatment regimen. This patient was treated with amphotericin B for 3 mo, while receiving concomitant therapy with an efavirenz-containing antiretroviral regimen, but cultures in ascitic fluid were persistently positive for P. marneffei. The infection resolved after treatment with high-dose voriconazole (400 mg every 12 h) for 3 mo. P. marneffei should be considered in the differential diagnosis of chylous ascites in human immunodeficiency virus patients. High-dose voriconazole is an effective, well-tolerated and convenient option for the treatment of systemic infections with P. marneffei in AIDS patients on an efavirenz-containing antiretroviral regimen.

Aislamiento de Candida spp. en ascitis de pacientes con cirrosis hepática / Isolation of Candida spp. from ascites in cirrhotic patients

El aislamiento de Candida spp. en el líquido ascítico (LA) de pacientes cirróticos es una situación infrecuente en la práctica clínica. Los factores que principalmente se han relacionado con una mayor predisposición a la peritonitis fúngica primaria (PFP) son la exposición a antibióticos de amplio espectro junto con la inmunosupresión, que es una situación característica de estos pacientes. Aportamos 7 episodios de aislamiento de Candida spp. en ascitis de pacientes cirróticos detectados en nuestro centro en los últimos 15 años

The isolation of Candida spp. in ascites of cirrhotic patients is an uncommon situation in clinical practice. Factors that have been associated with increased susceptibility to primary fungal peritonitis are exposure to broad-spectrum antibiotics and immunosuppression, a typical situation of these patients. We report seven episodes of Candida spp. isolation in ascites of cirrhotic patients detected in our hospital during the past 15 years