Idiopathic chronic polyserositis with massive ascites responding to colchicine in an adult: A case report

Abstract

Objective: While there are many different causes of ascites, most cases are due to cirrhosis. However, a serum/ascites albumin gradient <1.1 indicates that the ascites is not induced by portal hypertension and mandates a search for other etiologies, including causes of serositis. We describe a 70-year-old patient with persistent ascites and pleuropericarditis who underwent a successful outcome while on colchicine treatment. Methods:This study was delineated on a case-report basis. Besides supportive care measures, we performed a comprehensive clinical and complementary assessment of the patient, which included laboratory tests, imaging techniques, endoscopic evaluation, full microbiological and pathological studies, diagnostic laparoscopy and thoracoscopy, and genetic testing for autoinflammatory diseases. Results:Diagnostic workup failed to demonstrate the presence of an underlying etiologic disorder. Large-volume paracentesis was performed once monthly during 13 consecutive months due to painless, massive accumulation of peritoneal fluid. Eventually, colchicine therapy induced a dramatic response with clinical and radiological disappearance of polyserositis within three months of starting on the drug. While on colchicine, the disease has not recurred throughout a thirty two months period of follow-up so far. To our knowledge, the occurrence of idiopathic, chronic refractory ascites and pleuropericarditis resolved under colchicine treatment in an adult not diagnosed with Familial Mediterranean Fever is an exceptional event.Conclusion: We suggest that in adult patients suffering from idiopathic chronic polyserositis including massive ascites the possible existence of an underlying autoinflammatory condition should be sought. In such a case, a colchicine trial might be regarded as an early suitable therapeutic option.