[Spontaneous bacterial peritonitis in cardiac ascites: A case report and review of the literature].

Cardiac ascites accounts for approximately 5% of ascites cases and is typically characterized by high protein concentration, which is thought to confer protection against spontaneous bacterial peritonitis. Nevertheless, spontaneous bacterial peritonitis may develop in the setting of advanced heart failure due to intestinal congestion and impaired perfusion. We present the case of a 65-year-old male with advanced heart failure, a left ventricular ejection fraction of 19%, severe tricuspid regurgitation, and pulmonary hypertension, who presented with dyspnoea and progressive abdominal distension. Imaging excluded portal hypertension and cirrhosis. Ascitic fluid analysis revealed a protein concentration of 3.5 g/dL, a serum-ascites albumin gradient of 2.2 g/dL, and 89% polymorphonuclear cells, confirming spontaneous bacterial peritonitis. The patient responded favourably to antibiotic therapy. Although uncommon, spontaneous bacterial peritonitis should be considered in cardiac ascites, as prompt recognition and treatment are crucial to reduce morbidity and mortality.