Elusive Edema: A Case of Nephrotic Syndrome Mimicking Decompensated Cirrhosis.

Background: Patients admitted to the hospital from the emergency department are often evaluated with inherent diagnostic biases, particularly when the admitting diagnosis is anchored early. When a patient presents with suspected decompensated cirrhosis, it is important to consider other diagnoses with similar presentations and ensure multiple disease processes are not contributing to the symptoms.

Case presentation: A 64-year-old male without stable housing was admitted for management of newly diagnosed decompensated cirrhosis based on imaging. Additional analysis of laboratory results, imaging, and clinical presentation suggested that the decompensated cirrhosis diagnosis was not proportionate to the severity of the patient's hypoalbuminemia. Additional workup was conducted, and hepatology, nephrology, and infectious disease specialists were consulted. Extensive laboratory workup and a renal biopsy confirmed a diagnosis of compensated cirrhosis and nephrotic syndrome due to early membranoproliferative glomerulonephritis, both secondary to hepatitis C infection.

Conclusions: This case offers important teaching points on nephrotic syndrome and hepatitis C, and highlights the importance of re-evaluating diagnostic assumptions to prevent delays and errors.