Low-gradient ascites and extensive peritoneal implants.
A healthy 23-year-old man who emigrated from Ethiopia at the age of 5 years was admitted with diffuse abdominal pain, anorexia, weight loss and vomiting for over six weeks. He was found to be febrile (38.9°C), but examination was non-contributory and chest X-ray was normal. Hemoglobin was 11.2 g/dl, WBC 6.4 × 103/µl, platelets 394 × 103/µl with normal urinalysis and serum chemistry. Serum albumin was 3.3 g/dl and globulins 3.8 g/dl showing increased α1, α2 and γ fractions on electrophoresis. Erythrocyte sedimentation rate (ESR) was 66 mm/h, C-reactive protein 170 mg/dl. Abdominal ultrasound was normal except for some ascitic fluid in the lower abdomen. A tap yielded clear fluid with 2.6 g/dl …