• Shahem Abbarh, Amr Farwati, Nedia Neffati, and Mhd Baraa Habib.
• Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
• Medicine (Baltimore). 2022 Sep 23; 101 (38): e30708.

IntroductionAlthough ascites is a common complication of congestive heart failure, the association between heart failure and hemorrhagic ascites is quite rare.Patient ConcernsA 64-year-old woman with recurrent large bloody ascites secondary to heart failure.DiagnosisAscitic fluid assessment revealed red blood cells of 75,125/mm3 and white blood cells of 225/mm3. The total protein in the ascitic fluid was 28.7 g/L, with a high serum ascites albumin gradient. Peritoneal fluid examinations for bacterial culture, acid-fast bacilli (smear and culture), and malignant cell cytology were negative.InterventionsThe patient was managed with therapeutic paracentesis, aggressive diuresis, and optimization of her heart failure medications.OutcomesThe patient's symptoms improved dramatically and was discharged in a stable condition.ConclusionCongestive heart failure should be considered as a potential cause of hemorrhagic ascites after ruling out other serious causes.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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