Idiopathic chylous ascites in a patient with HIV infection: response to total parenteral nutrition and octreotide therapy

The authors describe a 47-year-old man infected with human immunodeficiency virus admitted for ascites and weight loss. Ascitic fluid analysis revealed chylous ascites (triglycerides 444 mg/dl) with negative microbiological tests. Neoplasia, cardiac disease and liver cirrhosis were excluded after an extensive diagnostic workout. Exploratory laparotomy with tissue sampling did not clarify ascites etiology. During hospital admission, patient status gradually deteriorated, severe malnutrition developed and ascites became refractory to diuretics. Total parenteral nutrition and octreotide therapy were started and maintained for 3 weeks with ascites resolution and no relapse after oral diet resumption. Chylous ascites is a rare entity with several causes that compromise intra-abdominal lymphatic drainage. This case illustrates the difficulty in establishing etiology in some patients and the effectiveness of total parenteral nutrition plus octreotide therapy in idiopathic chylous ascites in HIV-infected patients.