Insidious onset of massive painless ascites as initial manifestation of systemic lupus erythematosus.

Ascites in systemic lupus erythematosus (SLE) had once been thought to only occur as a consequence of nephrotic syndrome, protein-losing enteropathy, constrictive pericarditis or Budd-Chiari syndrome. In more recent years, both acute and chronic lupus peritonitis have been documented as another major cause of lupus ascites. Acute lupus peritonitis with ascites tends to develop rapidly, is accompanied by significant abdominal pain and is often associated with other symptoms of lupus flares such as fevers, arthritis, and rashes. On the other hand, chronic lupus peritonitis with ascites develops over several months, is recurrent, and tends to be recalcitrant to treatment with systemic steroids. We present the case of an 18-year-old African-American female whose initial presentation of SLE was gradual onset of massive painless ascites accompanied by anorexia, nausea, vomiting, and diarrhea. The ascites responded well to steroids and immunosuppressive therapy and has not recurred.