Spontaneous Bacterial Peritonitis in a Patient With Nonportal Hypertensive Ascites

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening condition classically found as a complication of cirrhotic ascites, but it has rarely been documented in a case of nonportal hypertensive ascites. Case Report: We report the case of a 54-year-old male with SBP arising from nonportal hypertensive ascites in the setting of end-stage renal disease and restrictive cardiomyopathy, both secondary to primary amyloidosis (AL type, kappa light chain). Peritoneal fluid analysis showed a serum-ascites albumin gradient of 1.1 g/dL and total fluid protein of 3.6 g/dL consistent with nonportal hypertensive etiology. The patient was managed empirically with intravenous ceftriaxone and intravenous albumin. Additional workup was nondiagnostic for other causes of ascites, and the patient was discharged after a 7-day hospital course. Conclusion: Patients presenting with refractory ascites in the setting of end-stage renal disease, cardiomyopathy, and long-standing immunosuppressive therapy may be at increased risk for SBP despite a high ascitic fluid protein.