Asites in Sarcoidosis

Document Type

Conference Proceeding

Publication Date


Publication Title

American Journal of Respiratory Care and Critical Care Medicine


ntroduction. Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseatinggranuloma formation. It can potentially involve any organ in the body and cause varied clinicalmanifestations but typically affects the lungs and intra-thoracic lymph nodes. Other commonextrapulmonary sites include the skin, reticuloendothelial system and eyes. We present a case ofnew onset ascites and spontaneous bacterial peritonitis in a patient with known systemicsarcoidosis. Case Description A 73-year-old woman with systemic sarcoidosis on chronicprednisone, end stage renal disease presented to the ED with a 2-day history of malaise,abdominal pain and decreased urination. She denied any other associated symptoms but reportedmissing one dialysis session 2 days ago due to her symptoms. Past medical history was alsosignificant for heart failure with preserved ejection fraction. She was noted to be drowsy andconfused on arrival. Vitals were notable for fever 102.1, hypotension 89/28, tachycardia 112. Examwas unremarkable except for being chronically ill appearing, drowsy and having pitting edema ofbilateral lower extremities. Workup was remarkable for a leukocytosis of 15.6, BUN 84, new largevolume ascites on CT abdomen/pelvis. Liver function tests were within normal limits. She wasadmitted to the ICU for septic shock requiring pressors but was able to be weaned off quickly andmental status improved after broad spectrum IV antibiotics (Vancomycin, Cefepime andMetronidazole) were started. Paracentesis was performed and revealed an absolute neutrophilcount of 273, total protein 3.5g/dl, SAAG 1.1. CA 125 of the fluid was elevated at 2730. Fluid cultureand cytology were negative for organisms and atypical cells. Ultrasound of the liver was negative forcirrhosis and liver masses/lesions. Echocardiogram showed evidence of pulmonary hypertensionthat was confirmed with right heart catheterization. She completed therapy for SBP with ceftriaxone.The ascites did not recur during the hospitalization.Discussion Ascites is a rare manifestation ofsarcoidosis and elevated CA-125 levels in ascitic fluid in patients with sarcoidosis have beenreported previously in literature. Ascites may occur due to portal hypertension related to liverinvolvement or severe pulmonary involvement as in our case with a SAAG greater than or equal to1.1 g/dL and peritoneal involvement with a SAAG lower than 1.1 g/dL.





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International Conference of the American Thoracic Society, May 19-24, 2023, Washington, DC