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Case Report

Systemic Lupus Erythematosus with Initial Presentation of Ascites

Ji Min Chu, San Ha Kang, Ji Hyun Song, Kyu Hyun Han, Sun Young Shin, Tae Young Yang, Jin Jung Choi, Sung Pyo Hong
The Ewha Medical Journal 2014;37(2):121-125. Published online: September 30, 2014

Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Corresponding author: Sung Pyo Hong. Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea. Tel: 82-31-780-5214, Fax: 82-31-780-5219, sphong@cha.ac.kr
• Received: March 15, 2014   • Accepted: May 19, 2014

Copyright © 2014. Ewha Womans University School of Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology and is characterized by presence of variable pathogenic auto-antibodies and multiple organ involvement. Serositis is common in SLE, but peritoneal involvement is relatively rare. This is a case report of 28-year-old female who initially presented with abdominal pain and ascites. After ruling out many other possibilities such as liver cirrhosis, neoplasm, and infectious etiologies, we confirmed SLE with clinical features, serologic tests and radiological findings. To conclude, her abdominal pain and ascites were caused by lupus peritonitis. After administration of corticosteroid therapy, her symptoms fairly improved.
  • Keywords: Systemic lupus erythematosus; Ascites; Peritonitis
  • 1. Hwangbo Y, Jung JH, Shim JJ, Kim BH, Jung SH, Lee CK, et al. Etiologic and laboratory analyses of ascites in patients who underwent diagnostic paracentesis. Korean J Hepatol 2007;13:185-195.
  • 2. Kirby JM, Jhaveri KS, Maizlin ZV, Midia M, Haider E, Khalili K. Abdominal manifestations of systemic lupus erythematosus: spectrum of imaging findings. Can Assoc Radiol J 2009;60:121-132.
  • 3. Rochling FA, Zetterman RK. Management of ascites. Drugs 2009;69:1739-1760.
  • 4. Forouhar-Graff H, Dennis-Yawingu K, Parke A. Insidious onset of massive painless ascites as initial manifestation of systemic lupus erythematosus. Lupus 2011;20:754-757.
  • 5. Pott Junior H, Amate Neto A, Teixeira MA, Provenza JR. Ascites due to lupus peritonitis: a rare form of onset of systemic lupus erythematosus. Rev Bras Reumatol 2012;52:116-119.
  • 6. Weinstein PJ, Noyer CM. Rapid onset of massive ascites as the initial presentation of systemic lupus erythematosus. Am J Gastroenterol 2000;95:302-303.
  • 7. Lee JS, Choi YJ, Lee WK, Lee CH, Song CH, Lee SK. A case of systemic lupus erythematosus with ascites as the initial presenting manifestation. J Korean Rheum Assoc 1997;4:88-92.
  • 8. Basaran A, Tuncer ZS. SLE and CA-125. Gynecol Oncol 2006;100:444-445.
  • 9. Basaran A, Zafer Tuncer S. Ascites is the primary cause of cancer antigen-125 (CA-125) elevation in systemic lupus erythematosus (SLE) patients with nephrotic syndrome. Med Hypotheses 2007;68:197-201.
  • 10. Mier A, Weir W. Ascites in systemic lupus erythematosus. Ann Rheum Dis 1985;44:778-779.
  • 11. Choi W, Kim YS, Shin YW, Lee DH, Cho HG, Kim HG, et al. A case of systemic lupus erythematosus with initial clinical presentation of recurrent peritonitis. Korean J Gastroenterol 1999;34:555-558.
  • 12. Choi JY, Lee SH, Seo SU, Koo C, Ji HY. A case of systemic lupus erythematosus with initial clinical presentation of peritonitis. Chonnam Med J 2006;42:227-229.
  • 13. Lin HP, Wang YM, Huo AP. Severe, recurrent lupus enteritis as the initial and only presentation of systemic lupus erythematosus in a middle-aged woman. J Microbiol Immunol Infect 2011;44:152-155.
  • 14. Bae JG, Jung HC, Choi SW, Park BH, Kim SH, Hong ES. Extensive enteritis with rapid onset of massive ascites as the initial presentation of systemic lupus erythematosus. J Korean Soc Emerg Med 2012;23:284-287.
  • 15. Tan TC, Wansaicheong GK, Thong BY. Acute onset of systemic lupus erythematosus with extensive gastrointestinal and genitourinary involvement. Lupus 2012;21:1240-1243.
Fig. 1
Chest X-ray. It reveals bilateral pleural effusion.
emj-37-121-g001.jpg
Fig. 2
Abdominal and pelvic computed tomography, cross-sectional (A) and coronal (B) view. Computed tomography scans show massive ascites, diffuse mural thickening of stomach, and bowel loops.
emj-37-121-g002.jpg
Table 1
Cases of systemic lupus erythematosus patients who initially presented with gastrointestinal symptoms

Hb, Hemoglobin; ESR, Erythrocyte sedimentation rate; CRP, C reactive protein; ANA, Anti nuclear antibody; Anti-RNP, Anti ribonucleoprotein antibody; Anti-Sm Ab, Anti smith antibody; Anti-Ro antibody, Anti-SSA antibody; Anti-La antibody, Anti-SSB antibody.

emj-37-121-i001.jpg

Figure & Data

Fig. 1
Chest X-ray. It reveals bilateral pleural effusion.
emj-37-121-g001.jpg
Fig. 2
Abdominal and pelvic computed tomography, cross-sectional (A) and coronal (B) view. Computed tomography scans show massive ascites, diffuse mural thickening of stomach, and bowel loops.
emj-37-121-g002.jpg
Table 1
Cases of systemic lupus erythematosus patients who initially presented with gastrointestinal symptoms

Hb, Hemoglobin; ESR, Erythrocyte sedimentation rate; CRP, C reactive protein; ANA, Anti nuclear antibody; Anti-RNP, Anti ribonucleoprotein antibody; Anti-Sm Ab, Anti smith antibody; Anti-Ro antibody, Anti-SSA antibody; Anti-La antibody, Anti-SSB antibody.

emj-37-121-i001.jpg

References

  • 1. Hwangbo Y, Jung JH, Shim JJ, Kim BH, Jung SH, Lee CK, et al. Etiologic and laboratory analyses of ascites in patients who underwent diagnostic paracentesis. Korean J Hepatol 2007;13:185-195.
  • 2. Kirby JM, Jhaveri KS, Maizlin ZV, Midia M, Haider E, Khalili K. Abdominal manifestations of systemic lupus erythematosus: spectrum of imaging findings. Can Assoc Radiol J 2009;60:121-132.
  • 3. Rochling FA, Zetterman RK. Management of ascites. Drugs 2009;69:1739-1760.
  • 4. Forouhar-Graff H, Dennis-Yawingu K, Parke A. Insidious onset of massive painless ascites as initial manifestation of systemic lupus erythematosus. Lupus 2011;20:754-757.
  • 5. Pott Junior H, Amate Neto A, Teixeira MA, Provenza JR. Ascites due to lupus peritonitis: a rare form of onset of systemic lupus erythematosus. Rev Bras Reumatol 2012;52:116-119.
  • 6. Weinstein PJ, Noyer CM. Rapid onset of massive ascites as the initial presentation of systemic lupus erythematosus. Am J Gastroenterol 2000;95:302-303.
  • 7. Lee JS, Choi YJ, Lee WK, Lee CH, Song CH, Lee SK. A case of systemic lupus erythematosus with ascites as the initial presenting manifestation. J Korean Rheum Assoc 1997;4:88-92.
  • 8. Basaran A, Tuncer ZS. SLE and CA-125. Gynecol Oncol 2006;100:444-445.
  • 9. Basaran A, Zafer Tuncer S. Ascites is the primary cause of cancer antigen-125 (CA-125) elevation in systemic lupus erythematosus (SLE) patients with nephrotic syndrome. Med Hypotheses 2007;68:197-201.
  • 10. Mier A, Weir W. Ascites in systemic lupus erythematosus. Ann Rheum Dis 1985;44:778-779.
  • 11. Choi W, Kim YS, Shin YW, Lee DH, Cho HG, Kim HG, et al. A case of systemic lupus erythematosus with initial clinical presentation of recurrent peritonitis. Korean J Gastroenterol 1999;34:555-558.
  • 12. Choi JY, Lee SH, Seo SU, Koo C, Ji HY. A case of systemic lupus erythematosus with initial clinical presentation of peritonitis. Chonnam Med J 2006;42:227-229.
  • 13. Lin HP, Wang YM, Huo AP. Severe, recurrent lupus enteritis as the initial and only presentation of systemic lupus erythematosus in a middle-aged woman. J Microbiol Immunol Infect 2011;44:152-155.
  • 14. Bae JG, Jung HC, Choi SW, Park BH, Kim SH, Hong ES. Extensive enteritis with rapid onset of massive ascites as the initial presentation of systemic lupus erythematosus. J Korean Soc Emerg Med 2012;23:284-287.
  • 15. Tan TC, Wansaicheong GK, Thong BY. Acute onset of systemic lupus erythematosus with extensive gastrointestinal and genitourinary involvement. Lupus 2012;21:1240-1243.

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    Systemic Lupus Erythematosus with Initial Presentation of Ascites
    Ewha Med J. 2014;37(2):121-125.   Published online September 30, 2014
    DOI: https://doi.org/10.12771/emj.2014.37.2.121
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    Systemic Lupus Erythematosus with Initial Presentation of Ascites
    Ewha Med J. 2014;37(2):121-125.   Published online September 30, 2014
    DOI: https://doi.org/10.12771/emj.2014.37.2.121
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    Systemic Lupus Erythematosus with Initial Presentation of Ascites
    Image Image
    Fig. 1 Chest X-ray. It reveals bilateral pleural effusion.
    Fig. 2 Abdominal and pelvic computed tomography, cross-sectional (A) and coronal (B) view. Computed tomography scans show massive ascites, diffuse mural thickening of stomach, and bowel loops.

    Fig. 1

    Fig. 2

    Systemic Lupus Erythematosus with Initial Presentation of Ascites

    Cases of systemic lupus erythematosus patients who initially presented with gastrointestinal symptoms

    Hb, Hemoglobin; ESR, Erythrocyte sedimentation rate; CRP, C reactive protein; ANA, Anti nuclear antibody; Anti-RNP, Anti ribonucleoprotein antibody; Anti-Sm Ab, Anti smith antibody; Anti-Ro antibody, Anti-SSA antibody; Anti-La antibody, Anti-SSB antibody.
    Table 1 Cases of systemic lupus erythematosus patients who initially presented with gastrointestinal symptoms

    Hb, Hemoglobin; ESR, Erythrocyte sedimentation rate; CRP, C reactive protein; ANA, Anti nuclear antibody; Anti-RNP, Anti ribonucleoprotein antibody; Anti-Sm Ab, Anti smith antibody; Anti-Ro antibody, Anti-SSA antibody; Anti-La antibody, Anti-SSB antibody.

    Table 1

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