Recurrent massive ascites three months after liver autotransplantation

Abstract

A 20-year-old woman with advanced hepatic alveolar echinococcosis (HAE) underwent liver autotransplantation [1] successfully 3 months prior to admission. Large-volume ascites (Fig.1) was revealed by ultrasonography five days prior to admission. She was treated with an abdominal drain and about 900 mL pale-yellow liquid was drained daily. Serum total protein (TP) was 62.9 g/dL and serum ascites albumin gradient (SAAG) was 6.7 g/dL. Left hepatic vein-inferior vena cava anastomotic stenosis was questionably diagnosed after excluding small-for-size syndrome (SFSS). And, she was treated tentatively stent implantation. The ascites, however, continues to increase, accompanied by pleural effusion and intermittent fever (38.5–40.8 C). Laboratory evaluation showed hemoglobin 57 g/dL, white blood cell counts 5.48 10 cells/uL, TP 56.5 g/dL, elevated procalcitonin (11.37 ng/mL), SAAG 15.3 g/dL, and negative results of tuberculosis antibodies and Mycobacterium tuberculosis DNA (TB-DNA) from pleural fluid, ascites, and sputum. Pleural fluid examination revealed elevated lactate dehydrogenase (5329 IU/L) but normal adenosine deaminase (64.1 IU/L). Repeated sputum culture showed no positive results for acid-fast bacilli, and T-spot test was suspected positive. No tuberculous lesions were found in the peritoneum or pleura via endoscopy. Venous