Necrotic pseudoxanthomatous nodules of the ovary and peritoneum pre- senting as haemorrhagic ascites

A 30-year-old woman presented with a four-week history of abdominal swelling. She had a long history of hormonal treatment for infertility but pregnancy test was negative. On ultrasound she was seen to have a large volume of ascites which was found to be haemorrhagic on insertion of an ascitic drain. Ascitic fluid cytology, culture and tuberculosis PCR were negative. An MRI pelvis confirmed large volume haemorrhagic ascites and showed a left sided ovarian cyst with possible haemorrhage. At laparoscopy the most notable findings were widespread necrotic-looking masses, biopsies of which excluded malignancy but revealed necrotic pseudoxanthoma cells, a rare manifestation of endometriosis. Although the patient initially declined surgery and treatment for her endometriosisin order to try for a pregnancy with in vitro fertilisation her symptoms recurred. She thus proceeded to laparoscopy andremoval of ovarian cysts. She is currently on goserelin with no recurrence of symptoms