Sperm in peritoneal fluid from a man with ascites: a case report
© Olteanu et al; licensee BioMed Central Ltd. 2009
Received: 19 September 2009
Accepted: 12 November 2009
Published: 12 November 2009
The finding of sperm in body fluids such as peritoneal fluid is unusual, and has been mostly described in female patients.
We are reporting the case of a 52-year-old man who presented with complaints of increased abdominal girth, weight gain and epigastric pain. He was subsequently found to have spontaneous bacterial peritonitis and sperm in the peritoneal fluid. We describe the laboratory findings and clinical course in this patient.
To our knowledge, this is the first report of sperm in peritoneal fluid in a male patient.
A 52-year-old Indian man with a history of cirrhosis, alcoholic liver disease, esophageal varices, hemolytic anemia, and type 2 diabetes mellitus presented with a 2-week history of increased abdominal girth, 15 pounds of weight gain and epigastric pain. He also complained of decreased energy and shortness of breath with exercise and denied any other changes, including fever, chills, nausea and vomiting.
His past medical history was significant for two decades of heavy alcohol consumption (approximately 325 mL whiskey daily), which led to alcoholic cirrhosis, portal hypertension with gastric and esophageal varices, ascites, and a left pleural effusion at the age of 50. The patient had stopped alcohol consumption 18 months prior to the current presentation. He also had a history of diabetes and hyperlipidemia since age 45; gastritis with H. pylori infection since age 50; and autoimmune hemolytic anemia since age 51. His oral home medications were Captopril 50 mg daily, Folic acid 1 mg daily, Furosemide 20 mg daily, Glipizide 5 mg daily, Prednisone 80 mg daily, and Spironolactone 50 mg daily.
The patient had no drug allergies and was married, with two adult children. He was employed as an electrician. The patient did not smoke tobacco and had no history of illicit drug use.
His past family history was significant for his mother having been diagnosed with diabetes.
At admission, the patient was alert and in no acute distress, with a pulse of 80/min, blood pressure 104/62 mmHg, respiratory rate 18/min, temperature 99 degrees Fahrenheit, and 100% oxygen saturation on room air. Significant findings on physical exam were slight conjunctival pallor and scleral icterus; a distended abdomen which was minimally tender to palpation and with full, shifting dullness to percussion; and 1+ bilateral lower extremity pitting edema.
There are anecdotal reports of women becoming pregnant via semen entering the abdominal cavity, secondary to various injuries. One case of so-called "oral conception" describes a patient with aplastic vagina who became pregnant through semen migrating in the peritoneal space following a knife stab wound in the stomach, shortly after she had engaged in oral intercourse . A similar situation was reported during the American Civil War, when a bullet injured the testis of a solider and then became lodged in the abdomen of a young nurse who provided care to the injured nearby. The woman became pregnant and delivered an infant that was later operated on and found to have a bullet lodged in his scrotum. Of note, the woman had an intact hymen and did not report prior sexual intercourse .
To our knowledge, this is the first report of sperm in peritoneal fluid in a male patient. From a patient care perspective, the recognition of this finding was important, since it suggested the presence of additional co-morbidities, which required specific tests in order to be ruled out. It also emphasized that good laboratory practices are paramount in ensuring that unusual findings are not due to specimen contamination in the preanalytical and analytical stage.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We thank Dr. Michael Lankiewicz for assistance in obtaining consent for the publication of the case report. We thank Dr. Jay Sandlow for helpful discussions.
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