Autoimmune Ascites Responding to Mycophenolate Mofetil: A Case Report

Area of Science:

• Gastroenterology and Immunology
• Internal Medicine
• Clinical Case Reports

Background:

• Ascites, characterized by peritoneal fluid accumulation, commonly stems from portal hypertension due to cirrhosis.
• Malignancy, heart failure, tuberculosis, and pancreatic disease are other recognized causes of ascites.
• Autoimmune ascites has not been previously documented in medical literature.

Observation:

• A 67-year-old male presented with refractory ascites, including abdominal distention and weight gain.
• A three-year diagnostic workup revealed a serum-ascites albumin gradient > 1.1 g/dL and ascitic fluid protein of 3.0 g/dL.
• Peritoneal biopsies showed minimal inflammatory changes, and common/rare causes of ascites were excluded.

Findings:

• The patient's ascites was refractory to standard treatments.
• Empiric treatment with mycophenolate mofetil (CellCept) led to symptom resolution.
• Symptom resolution persisted for over two years without the need for repeat paracentesis.

Implications:

• This case suggests autoimmune ascites as a potential, previously unreported etiology.
• Mycophenolate mofetil may be an effective treatment for autoimmune ascites.
• Further research is warranted to confirm autoimmune ascites and its therapeutic strategies.