Chylous ascites as an initial presentation of lupus nephritis

We report the case of a man in his 50s who presented with pleural and pericardial effusions, chylous ascites, lymphadenopathy, weight loss and fatigue. Extensive evaluation ruled out malignancy, infection and many autoimmune conditions, but test results were positive for antinuclear antibodies and anti-double-stranded DNA antibodies. A kidney biopsy showed evidence of lupus nephritis (class 5). He ultimately was diagnosed with systemic lupus erythematosus and lupus nephritis. The patient began immunosuppressive treatment, and the manifestations started to resolve. Recognition of systemic lupus erythematosus as the cause of chylous ascites was essential for identifying effective therapy.