Painless Progressive Abdominal Distension in a 5-Year-Old Girl

Abstract

A 5-year-old previously healthy, fully immunized, female of Filipino descent living in central Florida, United States presented to the hospital with unintentional weight loss for 8 months and progressively worsening abdominal distension for 5 months. She was otherwise asymptomatic. She was born in Yuba City, California, and traveled throughout the Southwest United States before moving to Florida 1 year prior to the onset of symptoms. Travel history was also notable for visits to the Philippines at 15 months and 4 years of age, where she was exposed to fresh water, catfish, chickens, cats, and dogs while staying at her grandparents' catfish farm. There were no known exposures to persons with tuberculosis disease; however, her father had a history of incomplete treatment for latent tuberculosis infection 10 years prior to her presentation.On admission, she was afebrile with normal vital signs. Her physical examination revealed non-tender abdominal distension. Her pulmonary examination was unremarkable; she had no appreciable hepatosplenomegaly or palpable lymphadenopathy. On the standard growth curve, she measured at the 76th percentile for height and 60th percentile for weight. Initial laboratory evaluation showed a platelet count of 402 × 10 3 /µL (reference range, 150-400 × 10 3 /µL), C-reactive protein of 6.7 mg/L (upper limit of normal <5 mg/L), and lactate dehydrogenase of 227 U/mL (reference range, 60-200 U/mL). Abdominal ultrasound confirmed ascites with low-level internal echoes throughout and irregular, shaggy appearing projections along the liver surface. Contrast-enhanced computed tomography (CT) of the chest, abdomen, and pelvis demonstrated large-volume ascites with enhancing nodularities in the peritoneum and along the surface of the liver, spleen, bladder, pelvis, hemidiaphragms, and bowel loops (Figure 1a). There was no abdominal, pelvic, or thoracic adenopathy.