Longstanding intractable ascites as the initial and predominant manifestation of systemic lupus erythematosus

Peritoneal involvement is quite common in systemic lupus erythematosus (SLE). However, significant ascites as the predominant manisfestations of SLE is extremely rare, and very few cases have been reported. We describe a patient with SLE whose disease first manifested as longstanding, painless and intractable ascites. The ascites preceded the diagnosis of SLE by 3 years. The diagnosis of SLE should be considered in patients with the so called "idiopathic" ascites. Once diagnosed, the ascites seem to respond promptly to corticosteroids, however, prior to their administration other potential causes, especially infections and malignancy, should be ruled out.