A rare cause for persistent ascites after liver transplantation

Excerpt

A 50-year-old man underwent living donor liver transplantation for hepatitis B-related decompensated cirrhosis. He had persistently low albumin with ascites (high drain output). At six weeks, his biochemical parameters were as follows; bilirubin 0.5 mg/dL, aspartate aminotransferase (AST) 28 IU/L, alanine transaminase (ALT) 30 IU/L, alkaline phosphatase (ALP) 64 IU/L, albumin 2.6 g/dL. His immunosuppression consisted of tacrolimus (level 5.3), mycophenolate (250 mg twice a day) and prednisolone. A urine examination did not show proteinuria. A diagnosis of protein-losing enteropathy was suspected and a gastroduodenoscopy with biopsies was done. Duodenal biopsy from the second part showed 2–5 µm basophilic bodies protruding from within the microvilli (marked with an arrow in Fig. 1), suggestive of cryptosporidium. Other causes were excluded. He was treated with Nitazoxanide 500 mg twice a day for two weeks. Serum albumin increased to 3.4 at two weeks after initiation of treatment, abdominal drain output progressively reduced and the drain was removed.

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