Abdominal distension and low grade fever in a refugee from Sudan

doi:10.1136/bmj.a1252

Published 10 September 2008, doi:10.1136/bmj.a1252
Cite this as: BMJ 2008;337:a1252

Endgames

Case report

Abdominal distension and low grade fever in a refugee from Sudan

Rachel J Ali, specialist registrar in gastroenterology¹, Harry R Dalton, consultant gastroenterologist and honorary senior lecturer¹^,2

¹ Cornwall Gastrointestinal Unit, Royal Cornwall Hospital, Truro, ² Peninsula College of Medicine and Dentistry, Royal Cornwall Hospital, Truro

harry.dalton@rcht.cornwall.nhs.uk

The first 150 words of the full text of this article appear below.

A 34 year old Sudanese refugee presented with a four month historyof malaise and generalised abdominal swelling. On examination,he had a temperature of 37.9°C and moderate ascites.

Initial investigations are as follows.

Alkaline phosphatase 171 U/l (3-110 U/l)
Alanine transaminase54 U/l (3-35 U/l)
Bilirubin 18 µmol/L (3-17 µmol/l)
Albumin 36 g/l (35-45 g/l)
International normalised ratio1.0
HIV negative
Normal chest radiograph
Abdominal ultrasonographyshowed moderate ascites, normal lookingliver, portal, and hepaticveins
Abdominal triphasic computed tomography confirmed ultrasonographyfindings, no other abnormality was seen
Bloodstained peritonealaspirate
White cell count 1250/µl (80% lymphocytes)
Albumin 27 g/l
Cytology negative (x2 samples)
Gram andacid fast bacilli stain negative (x2 samples)
Culture awaited