Filarial chylous ascites with chylothorax: challenge of diagnosis and management case report

Abstract

Chylous ascites (CA), an uncommon clinical condition, is defined as a milky-appearing, triglyceride-rich peritoneal fluid in the abdominal cavity. It may be due to malignancy or cirrhosis in developed countries or infections such as tuberculosis or filariasis in developing countries. This report presents a female patient with chylous ascites with chylothorax secondary to lymphatic filariasis after the exclusion of other etiologies. A 33-year-old female, from Damietta, Egypt, was referred to us complaining of abdominal distension and easy fatigability for 5 months. The patient was diagnosed to have elephantiasis of both lower limbs caused by filariasis and treated by ant-filarial therapy for 9 years. Aspirated ascitic fluid was milky in appearance and rich in triglyceride. All other causes of chylous ascites were excluded by ascetic fluid analysis (chemical, microbiological, and pathological). The patient was treated with diethylcarbamazine (DEC), albendazole, pheniramine, and hydrocortisone followed by a therapeutic pleural and ascitic tapping but ascites re-accumulate. With the addition of doxycycline and Somatostatin/ocreotide, the ascites gradually decreased. Three months later, the patient came back with a significant increase in ascites, and paracentesis was done. Despite rarity, filarial chylous ascites remains a challenge, and the only effective treatment is still repeated aspiration of the accumulated fluid. More work and discussion are needed.