25/10/2025
Physicians Forum: Today's Case
A 60-year-old lady who is known Diabetic and hypertensive on Oral Hypoglycemic Agents and ARBs noticed gradually increasing abdominal distension for past 6 months and low grade fever. She visited various health care facilities and worked up for Ascites. Two months ago peritoneal aspiration confirmed Exudative Ascites with high lymphocytes. She was started on antituberculous treatment (Rifa-4) which she took for 3-4 weeks but her distension increased. 1 week before admission to hospital she developed watery diarrhea, decreased urine output and fever 100 F. She was started on some antibiotics in addition to ATT. She then developed the rash mainly over calves and feet but also on forearms and trunk(See the attached picture). She also complained of severe abdominal Pain.
On examination she had tense ascites with tender abdomen, bowel sounds were audible. There were no stigmata of CLD and rest of the examination was unremarkable.
Lab Work: Creatinine 3.2, Urine C/ E microscopic haematuria, Normal Coagulation profile. Normal CBC.
A Diagnosis of drug induced Vs Malignancy related vasculitis was considered.
CA 125 was elevated (550).
Therapeutic Peritoneal Aspiration was performed and repeat fluid analysis came "POSITIVE FOR MALIGNANT CELLS". A CT scan chest and abdomen showed widespread nodules in Perotonium, omentum and around adenexae, which were otherwise reported Normal.
ATT was stopped, she was started on Prednisolone in tapering dose. Her rash improved, Creatinine returned to normal levels. Today the case was discussed in physician Forum which is a MDT platform based at Saleem Memorial Hospital.
A final diagnosis of Ovarian Malignancy/ Peritoneal Carcinomatosis, Henoch Schonlein purpura secondary to ATT/ Malignancy, AKI precipitated by diarrhea.
Oncologist recommended: CT guided peritoneal/ Omental biopsy for histopathology.
Suggestions comments are welcomed.
