A rare cause of ascites in a renal transplant recipient

Thirty-five-year-old man, underwent renal transplantation 4 years back and was doing well. He now presented with complaints of ascites with engorged neck veins and dyspnoea on exertion for last 6 months. Examination showed elevated jugular venous pressure with two prominent descents, high pitched di...

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Bibliographic Details
Published in:BMJ case reports 2018-09, Vol.2018, p.bcr-2018-226532
Main Authors: Kasinadhuni, Ganesh, Sethi, Jasmine, Krishnappa, Darshan, Sharma, Yash Paul
Format: Article
Language:English
Subjects:
Abdomen
Adult
Antitubercular Agents - administration & dosage
Antitubercular Agents - therapeutic use
Ascites - diagnosis
Ascites - etiology
Bacterial infections
Cardiomyopathy
Case reports
Diuretics - administration & dosage
Diuretics - therapeutic use
Echocardiography - methods
Edema
Etiology
Heart failure
Hernias
Humans
Infections
Kidney Transplantation - adverse effects
Liver diseases
Male
Neck
Patients
Pericardiectomy - methods
Pericarditis
Pericarditis, Constrictive - diagnostic imaging
Pericarditis, Constrictive - drug therapy
Pericarditis, Constrictive - microbiology
Pericarditis, Constrictive - pathology
Pericardium
Pericardium - diagnostic imaging
Pericardium - pathology
Reminder of Important Clinical Lesson
Transplants & implants
Treatment Outcome
Tuberculosis
Tuberculosis - complications
Tuberculosis - diagnosis
Tuberculosis - drug therapy
Ultrasonic imaging
Veins & arteries
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Description
Summary:Thirty-five-year-old man, underwent renal transplantation 4 years back and was doing well. He now presented with complaints of ascites with engorged neck veins and dyspnoea on exertion for last 6 months. Examination showed elevated jugular venous pressure with two prominent descents, high pitched diastolic heart sound (pericardial knock). Echocardiography showed characteristic features of thickened pericardium, septal bounce, expiratory flow reversal in hepatic veins and phasic variation of mitral inflow, suggestive of constrictive pericarditis. The patient was started on empirical antitubercular therapy and diuretics. The patient symptomatically improved, but in view of persisting constrictive physiology he was planned for pericardiectomy.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-226532