Question: A 12-year-old female with an unremarkable medical and developmental history presented with a 4-month progression of abdominal distension, anorexia, and bilateral lower limb edema. Initial treatment with diuretics at a local hospital partially alleviated the abdominal symptoms, although the peripheral edema remained refractory. On admission, physical examination confirmed grade 2 pitting edema of the lower extremities. Hematologic evaluation showed a white blood cell count of 3280/μL (76.2% neutrophils), hemoglobin of 15.9 g/ dL, and platelets of 215,000/μL.
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