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297 U/ml (normal <30 U/l ). Serological markers for Case hepatitis B and C and HIV were negative. A chest X-ray was unremarkable, with no signs of The patient is a 47-year-old Philippine woman with congestive heart failure or pulmonary infiltration, but end-stage renal disease since 1996 due to diabetic CT-scan of the chest a few days later revealed infiltrates nephropathy. She has been living in Germany since of the right lung and enlargement of a calcified 1982, but travelled to the Philippines each year for lymph node in the right mediastinum (Figure 1). some weeks for vacation. In the past medical history, Bronchoscopy was not performed. A CT scan of the enlargement of mediastinal lymph nodes was noticed abdomen and pelvis showed perihepatic ascites and since 1995, but without any pulmonary infiltrations. calcification of an enlarged lymph node para-aortal Mediastinoscopic biopsy at that time revealed a non(Figure 2). caseating granulomatous lymphadenitis. No further Diagnostic paracentesis revealed yellow clear ascitic work-up was done and several chest X-rays had been fluid with glucose 89 mg/dl, leukocytes 1300/ml, total unchanged in the following years. protein content 61 g/l, no erythrocytes, LDH 616 U/l, In February 1999 the patient reported persistent and cholesterol 78 mg/dl. Ascitic fluid cytology showed mild vaginal bleeding, night sweats, and low-grade predominantly lymphocytes and monocytes, some neufever. A weight loss of 5 kg and an erythropoietintrophils, but no malignant cells. No acid-fast bacilli resistant anaemia were noted. The physical examination revealed a tense abdomen but was otherwise normal. A tuberculin skin test was negative. Ultrasound showed large quantities of ascites in the whole abdomen, without signs of portal hypertension. A gynaecological pelvic examination was unremarkable. Laboratory examination revealed a microcytic anaemia with haemoglobin 9.2 g/dl, platelet count 444 000/ml, white cell count 8000/ml, with 70% neutrophils, 8% lymphocytes, 20% monocytes, 1% eosinophils, and 1% basophils in the differential count. Calcium, LDH, bilirubin, and liver enzymes were within normal limits. Serum albumin was slightly reduced to 39 g/l. As ovarian cancer was suspected, the serum level of CA 125 was measured and found to be increased to

The haemodialysis patient with night sweats, ascites, and increased CA 125