Clinical presentation

A 33-year-old man presented with a 2-week history of abdominal pain, vomiting and weight loss. There was no history of fever, diarrhoea or travel. In his medical history, he had had end-stage renal failure secondary to malignant hypertension and had been on peritoneal dialysis for 8 years before having a cadaveric renal transplant in 2008. He was taking tacrolimus and prednisolone since his renal transplant.

On examination he was afebrile, but tachycardic with a heart rate of 110 per minute and blood pressure of 90/70 mm Hg. Abdominal examination revealed normal bowel sounds and moderate ascites. A diagnostic tap of ascites …