PMC3700482_01
Abdominal US scan showed abundant ascites, with no other significant pathology.
amjcaserep-14-109-g001.jpg
PMC3700482_01_amjcaserep-14-109-g001.jpg
f1-amjcaserep-14-109
An abdominal ultrasound examination (Figure 1) confirmed the presence of ascites, but there was no enlargement of the liver or the spleen.
Abdominal TC scan confirming the presence of abundant ascitic fluid and no significant alterations in the remaining organs.
amjcaserep-14-109-g002.jpg
PMC3700482_01_amjcaserep-14-109-g002.jpg
f2-amjcaserep-14-109
A chest and abdomen CT scan (Figure 2) revealed bilateral apical scarring of the lung parenchyma and absence of hilar and mediastinal lymphoadenomegaly, and confirming the presence of abundant ascitic fluid.
Ascitic fluid cytology: abundant lymphocytes are present, along with Langhans-like polynucleated cells.
amjcaserep-14-109-g003.jpg
PMC3700482_01_amjcaserep-14-109-g003.jpg
f3-amjcaserep-14-109
Histological examination of the peritoneal biopsies showed epithelial granuloma with the presence of Langhans-type giant cells and a wide area of caseous necrosis, but without acid-fast bacilli Figure 3).
Peritoneal biopsy: cluster of epithelioid lymphocytes, with Langhans-type giant cells and a wide area of caseous Necrosis.
amjcaserep-14-109-g004.jpg
PMC3700482_01_amjcaserep-14-109-g004.jpg
f4-amjcaserep-14-109
Cytological examination of the ascitic fluid showed the presence of inflammatory cells, predominantly lymphocytes, monocytes, and a small number of polymorphonuclear cells, similar to Langhans cells (Figure 4).