Ascites in the "TAFRO" Syndrome: Does the Squeeze Make the Juice

Authors

Aamer Abbass, Division of Gastroenterology and Hepatology, University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USAFollow
Sameen Khalid, Division of Gastroenterology and Hepatology, University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA
Laura Toth, Department of Pathology, University of New Mexico, Albuquerque, NM, USA
Steven Eberhardt, Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM, USA
Denis McCarthy, Division of Gastroenterology and Hepatology, University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA

Document Type

Article

Publication Date

9-1-2020

Abstract

A 41-year-old healthy female underwent cholecystectomy due to symptomatic gallstone related acute cholecystitis. A week later she was readmitted with fatigue, low grade fever, worsening pallor, generalized edema including bilateral leg swelling and abdominal distension with pain. Laboratory evaluation showed mild normocytic anemia (Hgb 7 g/dL [12–16 g/dL]), mean corpuscular volume 92 fL (80–100 fL), mild leukocytosis with WBC count 12,000/µL (4000–11,000/µL), thrombocytopenia (platelet count 55,000/µL [150,000–400,000/µL]). Comprehensive metabolic panel showed normal serum electrolytes, blood urea nitrogen, creatinine, and liver profile, except for low serum total protein of 5.1 g/dL (6.1–8.2 g/dL) and hypoalbuminemia (albumin 2.4 g/dL [3.4–4.7 g/dL]). Urinalysis showed proteinuria and an elevated random protein-to-creatinine ratio of 3.8. A 24-h urine collection revealed an elevated total protein of 3.1 gm/24 h, consistent with nephrotic range proteinuria. A contrast computerized scan (CT) of chest, abdomen and pelvis showed moderate bilateral pleural effusions, and moderate ascites: no other abnormality was noted in the chest, abdomen, or pelvis. Diagnostic and therapeutic paracenteses were performed draining about 3000 ml of straw-colored fluid. Analysis showed a serum-ascites-albumin gradient (SAAG) of 1.9 g/dL with a normal cell count and negative cytology.

Recommended Citation

Abbass A, Khalid S, Toth L, Eberhardt S, McCarthy D. Ascites in the "TAFRO" Syndrome: Does the Squeeze Make the Juice? Dig Dis Sci. 2020 Sep;65(9):2522-2526. doi: 10.1007/s10620-020-06433-w. PMID: 32617769.