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This 56-year-old alcoholic presented with lethargy and increasing abdominal girth of six months’ duration. Her admitting diagnosiswas hepatic cirrhosis.

92. myxedema ascites

This patient’s facial features alone were enough to suggest hypothyroidism. In addition, she had a low-pitched voice, dry skin, andpseudomyotonic deep tendon reflexes. After two months of thyroid replacement therapy, she was asymptomatic and looking like her old self again (imagesbelow). Liver biopsy at that point showed normal findings.

This case emphasizes that alcoholism plus ascites doesn’t necessarily equal liver disease.

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Source:  OpenStax, Images of memorable cases: 50 years at the bedside. OpenStax CNX. Dec 08, 2008 Download for free at http://cnx.org/content/col10449/1.7
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