A 34 year old Sudanese refugee presented with a four month history of 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 transaminase 54 U/l (3-35 U/l)

• Bilirubin 18 μmol/L (3-17 μmol/l)

• Albumin 36 g/l (35-45 g/l)

• International normalised ratio 1.0

• HIV negative

• Normal chest radiograph

• Abdominal ultrasonography showed moderate ascites, normal looking liver, portal, and hepatic veins

• Abdominal triphasic computed tomography confirmed ultrasonography findings, no other abnormality was seen

• Bloodstained peritoneal aspirate

• White cell count 1250/µl (80% lymphocytes)

• Albumin 27 g/l

• Cytology negative (×2 samples)

• Gram and acid fast bacilli stain negative (×2 samples)

• Culture awaited