Abstract
Amlodipine besilate, long-acting dihydropyridine type calcium channel blocker is widely used as an antihypertensive agent. In some reports, long-acting dihydropyridine type calcium channel blockers caused chylous ascites in peritoneal dialysis patients. In other report, manidipine hydrochloride, one of the long-acting dihydropyridine type calcium channel blocker caused massive chylous ascites in a patient with systemic lupus erythematosus (SLE), who was not receiving peritoneal dialysis. Here, we describe a case of Japanese boy with SLE who developed massive ascites after the initiation of treatment with amlodipine besilate. About 10 days after the initiation of treatment with amlodipine besilate, he developed abdominal fullness without any edema, and massive ascites were shown in an abdominal sonogram, but after the discontinuation of this agent, his ascites began to decrease immediately and disappeared within about 3 weeks. We speculated that the continuous peritoneal lymph-vascular dilation due to amlodipine besilate caused massive ascites in our case, through the similar mechanism that long-acting dihydropyridine type calcium channel blockers cause chylous ascites in previous reports. Additionally, the asymptomatic peritoneal lymph-vascular inflammation associated with SLE may increase the peritoneal lymph-vascular permeability and affect the development of ascites. So we concluded that amlodipine besilate caused ascites due to the peritoneal lymph-vascular dilation effects in the background of asymptomatic peritoneal inflammation with SLE in our case. Clinicians should be aware of the possibility of ascites due to the administration of long-acting dihydropyridine type calcium channel blockers, particularly in patients with SLE.
