Suspected menopause nutraceutical-induced eosinophilic ascites: a rare clinical presentation

A middle-aged woman presented with a 2-month history of ascites without associated symptoms. She reported taking no regular medication, except for a menopause supplement for the preceding 4 months. Initial blood investigation revealed marked peripheral eosinophilia (49%) but was otherwise unremarkable. Analysis of the ascitic fluid demonstrated a predominance of eosinophils (90%) with no evidence of malignancy.Abdominal ultrasonography identified liver lesions; however, malignancy was excluded by CT. Gastroscopy findings were normal and biopsies showed no malignant features. Tumour markers were within normal limits, except for an elevated CA-125 level. Autoimmune and infectious causes were excluded and no other underlying cause for the ascites was identified.Following discontinuation of the dietary supplement, both the ascites and eosinophilia resolved within a month without specific treatment. The temporal relationship and subsequent clinical improvement after withdrawal highlight the supplement as a possible contributing factor to eosinophilic ascites and hypereosinophilia.