Massive Ascites as the Initial Manifestation of Systemic Lupus Erythematosus: A Case Report

Although systemic lupus erythematosus (SLE) can manifest differently in each patient, ascites is a rare first sign. The diagnosis of SLE can be easily missed when the initial presentation is uncommon. This is the case report of a 20 year old woman with no medical history, who experienced 8 months of abdominal distension and weakness, with concurrent 10 kg weight loss. She presented skin lesions of the erythematous type on the dorsal surface of her hands, non-scarring alopecia, Raynaud's syndrome, and joint involvement consisting of symmetrical distal polyarthralgia of the small joints. There were no signs of thyroid dysfunction, cardiac dysfunction, cancers, infectious diseases, hepatitis, kidney diseases, or other diseases.The investigation also allowed the confirmation of SLE. Thus, the hypothesis of lupus peritonitis with ascites became viable. The patient was treated with prednisone and MMF, with substantial improvement of her condition.