A 3-YEAR-OLD BOY was referred for evaluation of unilateral testicular swelling and abdominal and lower limb edema. His mother reported that he had been coughing and vomiting for 3 weeks prior to admission. Swelling began 4 weeks before admission. Physical examination showed extensive peripheral edema and ascites. There was no fever and his blood pressure was 106/56 mm Hg.
Laboratory findings were as follows: white blood cell count, 26.3 × 109 (62.7% lymphocytes); hemoglobin, 14.4 g/dL; albumin, 1.7 g/dL; potassium, 4.7 mmol/L; sodium, 132 mmol/L; glucose, 107 mg/dL (5.94 mmol/L); normal urine protein and amylase content; positive urine cytomegalovirus antigen; positive cytomegalovirus antibody, IgM and IgG; and stool α1-antitrypsin level was 15.2 mg per gram of dry weight stool.
Abdominal ultrasound showed bilateral pleural effusions and a large quantity of intraperitoneal fluid, an enlarged liver, and markedly thickened gastric rugae (Figure 1).
The boy was treated with antibiotics for his cough, intravenous albumin and furosemide for edema, and a diet of protein-enriched food. The swelling subsided and the abdominal diameter decreased during the next several weeks.
Sela R, Nussinovitch M, Ziv N, Volovitz B, Amir J, Wood BP. Radiological Case of the Month. Arch Pediatr Adolesc Med. 2001;155(11):1273-1274. doi:10.1001/archpedi.155.11.1273