Unraveling a Diagnostic Dilemma: Anasarca in a 35-Year-Old Patient

Introduction
Anasarca, also known as extreme generalized edema, presents a significant diagnostic challenge due to its multiple possible etiologies. This case report, published in the Archives of Case Reports, details the struggle of diagnosing a 35-year-old transporter experiencing severe anasarca with no clear underlying renal, hepatic, or cardiovascular cause. Visit https://www.hspioa.org/ for more groundbreaking research in this field.

Understanding Anasarca and Its Complex Causes
Anasarca results from fluid retention in the extracellular compartments, often due to imbalances in oncotic and hydrostatic pressure. Common causes include:

• Chronic kidney disease (CKD) or nephrotic syndrome
• Chronic liver disease or cirrhosis
• Congestive heart failure
• Septicemia or malignancies
• Uncommon conditions like tuberculosis-related capillary leak syndrome

In this case, despite clinical features suggesting kidney, liver, or heart involvement, diagnostic tests ruled out these common causes.

Diagnostic Challenges and Findings
The patient, a 34-year-old male, presented with progressive abdominal and leg swelling for three months, accompanied by dyspnea, weight loss, and mild hepatic enzyme abnormalities. Key findings included:

• Normal renal function tests: No proteinuria or creatinine abnormalities
• Liver function abnormalities: Mildly elevated AST/ALT, but normal albumin and no portal hypertension
• Cardiac assessment: No structural abnormalities suggestive of heart failure
• High ESR and exudative ascites: Suggesting an inflammatory process

These atypical findings complicated the diagnosis, necessitating a broader investigation.

The Role of Tuberculosis in Anasarca
Although rare, tuberculosis (TB) can present with anasarca due to systemic inflammation and capillary leak syndrome. The American Thoracic Society highlights the need for increased vigilance in endemic regions when evaluating patients with unexplained edema.

The patient was initiated on anti-tuberculosis therapy, including rifampicin, isoniazid, ethambutol, and pyrazinamide. Within a week, his condition markedly improved, confirming TB as the underlying cause of anasarca.

Further Reading and Study Access
For a comprehensive analysis of this case, read the full study at https://doi.org/10.29328/journal.acr.1001014.

Key Takeaways

• Anasarca is often associated with renal, hepatic, or cardiac conditions, but other rare causes must be considered.
• Tuberculosis can cause systemic edema through inflammatory mechanisms.
• A detailed, multidisciplinary diagnostic approach is essential for challenging cases.

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