SHM Converge Scientific Abstract ePoster Gallery-Ascites as a Presentation of Lupus

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This case report describes a 29-year-old Black woman who presented with abdominal pain, nausea, vomiting, diarrhea, abdominal distension, and ascites. Her initial workup suggested gastroenteritis and enteritis on CT scan, but her symptoms worsened over several hospital days, with increasing leukopenia and persistent distension. Diagnostic paracentesis revealed transudative ascites, and 24-hour urine protein showed proteinuria consistent with nephrotic-range concern. Autoimmune testing was strongly positive, including elevated ANA, SSA, SSB, ds-DNA, and antihistone antibodies, along with low C3 and C4 levels. Rheumatology confirmed systemic lupus erythematosus (SLE), and renal biopsy demonstrated class V lupus nephritis.<br /><br />The authors emphasize that lupus can present in highly atypical ways. Ascites is an uncommon initial manifestation of SLE, and serositis is present as the first symptom in only a small minority of patients. Lupus nephritis occurs in up to 40% of patients with SLE and is more common among non-White patients, particularly Black patients, and is associated with worse outcomes.<br /><br />A notable aspect of the case is the patient’s history of pneumococcal meningitis and septic arthritis three months earlier, suggesting she may have had undiagnosed SLE at that time. Because SLE itself can cause immune dysfunction, severe infection may sometimes be an early clue to underlying lupus, especially with encapsulated organisms such as pneumococcus.<br /><br />The report concludes that clinicians should maintain a high index of suspicion for SLE even when patients present without classic signs such as malar rash or arthritis, and should consider lupus in cases of unexplained ascites.

Asset Subtitle

Lorraine Vitek

Meta Tag

Author List J Richard Pittman, Lorraine Vitek, Matthew Udine, Michael Debakey MD, Rachel Lazris

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Cirrhotic Ascites

Concept ANA

Concept Anti-dsDNA Antibody

Concept Lupus Nephritis

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Lorraine Vitek

Track Adult

Keywords

systemic lupus erythematosus

lupus nephritis

ascites

serositis

proteinuria

antinuclear antibody

low complement

Black woman

pneumococcal meningitis

autoimmune disease

Systemic Lupus Erythematosus

Cirrhotic Ascites

ANA

Anti-dsDNA Antibody

Lupus Nephritis