title: Low albumin gradient ascites complicating severe pseudomembranous colitis.
abstract: Pseudomembranous colitis (PMC) is a frequently severe, sometimes fatal iatrogenic disease that is antibiotic-associated in almost all cases. The most common clinical features of PMC include abdominal pain, watery diarrhea, fever, leukocytosis, hypoalbuminemia, and hypovolemia. Ascites, not considered a well-known feature of PMC, is fairly common, based on a review of the English language literature but has not been characterized fully. This case report describes 5 patients with PMC who presented with low serum-ascites albumin gradient (SAAG) and neutrocytic ascites, without evidence of infectious, malignant, or inflammatory peritoneal disease, which has not been reported previously. In 1 patient, massive low SAAG ascites was the presenting manifestation of PMC, a feature also not reported previously. Three of the 5 (60%) patients had acquired immunodeficiency syndrome. The characteristics of the fluid specimens in these 5 patients and the possible pathogenetic mechanisms are proposed. The findings suggest that PMC should be included in the differential diagnosis of low SAAG ascites, especially in patients with acquired immunodeficiency syndrome.
authors.affiliation: Department of Medicine (Hepatology), Rancho Los Amigos Medical Center, Downey, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: E
authors.initials: E
authors.lastname: Zuckerman
authors.forename: G
authors.initials: G
authors.lastname: Kanel
authors.forename: C
authors.initials: C
authors.lastname: Ha
authors.forename: J
authors.initials: J
authors.lastname: Kahn
authors.forename: B S
authors.initials: BS
authors.lastname: Gottesman
authors.forename: J
authors.initials: J
authors.lastname: Korula
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D001201:Ascites / Q000209:etiology*; D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000633:toxicity; D004761:Enterocolitis, Pseudomembranous / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D012709:Serum Albumin; C031815:toxB protein, Clostridium difficile