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Case Report
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| Unusual case of ascites | ||||||
| Guido Poggi1, Benedetta Montagna1, Pamela Di Cesare1, Erica Quaquarini1, Emma Pozzi1, Carlo Aprile2 | ||||||
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1Department of Oncology II, IRCCS Maugeri Foundation, Pavia, Italy.
2Consultant, Department of Nuclear Medicine, IRCCS S. Matteo Hospital, Pavia, Italy. | ||||||
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| How to cite this article: |
| Poggi G, Montagna B, Di Cesare P, Quaquarini E, Pozzi E, Aprile C. Unusual case of ascites. International Journal of Case Reports and Images 2013;4(1):32–36 |
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Abstract
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Introduction:
Clostridium difficile infection is very commonly related to antibiotic therapy. The spectrum of clinical manifestation of C. difficile infection may include, in an increasing order of severity, absence of symptoms, colitis without formation of pseudomembranes and pseudomembranous colitis (PMC). PMC is a severe but rare complication of the infection. It is related to the bacterial production of enterotoxin A and B. Its clinical features include diarrhea, abdominal tenderness and fever. In the worst case, it may progress to toxic megacolon and colonic perforation. Ascites is an infrequent direct complication of most severe cases of PMC.
Case Report: We report a case of ascites arising two weeks after the resolution of C. difficile infection, in which hypoalbuminemia, caused by protein losing enteropathy, was the most likely pathogenetic mechanism. The patient recovered completely after human albumin intravenous support and diuretics. Conclusion: Protein losing syndrome represents a group of disorders in which hypoproteinemia and edema occur in the absence of either proteinuria or defects in protein synthesis. It is a consequence of the intestinal epithelial cell damage and increased mucosal permeability induced by C. difficile enterotoxin. The clinical manifestations are ascites and low serum albumin levels. The treatment requires human albumin intravenous integrations and diuretics. Ascites could be a direct complication of antibiotic-associated pseudomembranous colitis, but it could also be the manifestation of a protein-losing enteropathy, caused by inflammatory damage of gastrointestinal mucosa. | |
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Keywords:
Clostridium difficile, Infection, Complications, Protein losing enteropathy, Ascites, MSSA infection
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Author Contributions
Guido Poggi – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Benedetta Montagna – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Pamela Di Cesare – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Erica Quaquarini – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Emma Pozzi – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Carlo Aprile – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Guido Poggi et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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