A Case of TAFRO Syndrome in Which Differentiation from Hepatic Ascites Was Important Because of Hepatitis C Virus Infection

The patient was a Japanese male in his 70s who had previously been treated with an interferon preparation for chronic hepatitis C, but the treatment was ineffective. After edema appeared, computed tomography showed subcutaneous edema, pleural effusion, and ascites, and hepatic edema and ascites were initially suspected because of persistent hepatitis C virus (HCV) infection, thrombocytopenia, and a high FIB-4 index. Noninvasive testing (NIT), which included Mac2 binding protein glycosylation isomer (M2BPGi), ultrasound elastography, and congestion index of the portal vein, ruled out liver cirrhosis and hepatic ascites, and this case was ultimately considered to be TAFRO syndrome. The most common cause of ascites is liver cirrhosis, which is often treated by a hepatologist. Thus, it is important to objectively differentiate whether ascites is due to a hepatic cause using NIT. And since there have been no reports of HCV infection complicated by TAFRO syndrome, this case is rare and valuable.