# Noninfectious Ascites Neutrophilia in a Patient With Polycythemia Vera

## TL;DR

A patient with polycythemia vera had elevated neutrophils in ascites without infection, linked to a rare condition called omental extramedullary hematopoiesis.

## Contribution

Identifies omental extramedullary hematopoiesis as a rare cause of ascites neutrophilia unrelated to infection in polycythemia vera.

## Key findings

- Patient had persistent elevated PMN count in ascites despite antibiotic treatment and no symptoms.
- Multidisciplinary team attributed PMN elevation to polycythemia vera, not bacterial peritonitis.
- Diagnosis of omental extramedullary hematopoiesis was confirmed as the underlying cause.

## Abstract

A 59-year-old woman with polycythemia vera-related portal hypertension requiring frequent paracentesis was admitted for asymptomatic recurrent spontaneous bacterial peritonitis, which was diagnosed based on elevated polymorphonuclear (PMN) count. She had multiple similar admissions during which she was treated with antibiotics. The patient had chronic baseline leukocytosis due to polycythemia vera. Repeat paracentesis after intravenous antibiotics demonstrated persistent elevation of PMN count without clinical symptoms. A multidisciplinary team concluded that the increased PMN count was secondary to polycythemia. The patient was diagnosed with omental extramedullary hematopoiesis, a rare condition causing elevated PMN count in the absence of bacterial contamination.