[ASCITES AS MAIN PRESENTATION IN SYSTEMIC LUPUS ERYTHEMATOSUS]

Area of Science:

• Nephrology
• Rheumatology
• Internal Medicine

Background:

• Ascites can be a rare presenting symptom of systemic lupus erythematosus (SLE).
• Distinguishing SLE-induced ascites from other causes is crucial for appropriate management.
• Lupus glomerulonephritis is a common manifestation of SLE affecting the kidneys.

Purpose of the Study:

• To report a case of exudative ascites as the primary presentation of lupus glomerulonephritis grade IV.
• To illustrate the diagnostic challenges and treatment outcomes in such cases.

Main Methods:

• A 40-year-old female presented with acute onset ascites and abdominal pain.
• Diagnostic workup included ascitic fluid analysis, autoimmune markers, and renal biopsy.
• Treatment involved immunosuppressive therapy with oral prednisone and cyclophosphamide pulses.

Main Results:

• Ascitic fluid analysis revealed an exudate with negative results for infections and malignancy.
• Positive antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies, along with low serum complement levels, indicated SLE.
• Renal biopsy confirmed lupus glomerulonephritis grade IV.
• The patient showed gradual resolution of ascites following immunosuppressive treatment.

Conclusions:

• Lupus glomerulonephritis grade IV can manifest with exudative ascites.
• Early diagnosis and prompt immunosuppressive treatment are essential for managing SLE-related ascites.
• This case underscores the importance of considering SLE in patients with unexplained exudative ascites.