# A Rare Case of Lymphocytic Ascites

## TL;DR

A 37-year-old woman with lymphocytic ascites was found to have a rare case caused by Chlamydia trachomatis infection, highlighting the need for chlamydia testing in similar cases.

## Contribution

This case report highlights chlamydia as a rare but important cause of lymphocytic ascites in sexually active females.

## Key findings

- The patient's ascites was caused by Chlamydia trachomatis, diagnosed via PCR and nucleic acid amplification testing.
- Treatment with doxycycline led to clinical improvement and resolution of ascites.
- Lymphocytic predominance in ascitic fluid and absence of malignancy supported the infectious etiology.

## Abstract

Ascites can manifest as a result of many conditions, with cirrhosis being the most common cause in the United States. Here, we present a case of lymphocytic ascites, a less common variant that occurred due to infection with Chlamydia trachomatis. This was a 37-year-old female with a history of substance and sexual abuse who presented with the chief complaints of abdominal pain, abdominal distension, and weight gain. She was febrile on admission with a distended, tender abdomen. The more common cardiac, renal, and hepatic causes were ruled out with extensive workup. Diagnosis and therapeutic paracentesis were done with fluid analysis significant for lymphocyte predominance and absence of malignant cells. Multi-modal imaging had ruled out suspicious malignant masses but CT abdomen/pelvis did show complex large volume ascites. Urine chlamydia and gonorrhea polymerase chain reaction (PCR) had resulted positive for chlamydia, leading us to start Doxycycline. Other infectious workups were negative, but ascitic fluid chlamydia NAAT was positive. Though initially worsening, the patient started showing significant clinical improvement after starting doxycycline, with the resolution of ascites and associated symptoms. This case report intends to bring to attention the importance of testing for chlamydia infection in cases of lymphocytic ascites, especially in sexually active females.