SHM Converge Scientific Abstract ePoster Gallery-Case Report on a Patient With Ascites Due to Lupus Peritonitis in the Setting of Lupus Nephropathy

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This case report describes a 40-year-old man with coronary artery disease, end-stage renal disease from IgG4-related disease, and suspected systemic lupus erythematosus (SLE) who developed large-volume ascites, abdominal distension, vomiting, and diarrhea. Although ascites is an uncommon manifestation of SLE, it can result from lupus peritonitis or other lupus-related complications such as nephritis, nephrotic syndrome, serositis, or vasculitis.<br /><br />On presentation, imaging showed marked ascites and body wall edema. Paracentesis revealed an exudative process, with ascitic fluid studies and the clinical picture helping rule out common infectious and malignant causes. Inflammatory markers were elevated, complement was low, and dsDNA antibodies were positive, supporting active lupus disease. Additional workup also demonstrated cardiomyopathy with reduced biventricular function.<br /><br />The patient had previously been considered to have probable SLE during an earlier admission because of positive autoantibodies and multi-organ findings, but the diagnosis had not been definitive due to overlapping illness from his existing renal disease. During the current admission, he was initially treated empirically for spontaneous bacterial peritonitis, but antibiotics were stopped after fluid analysis suggested noninfectious ascites. His gastrointestinal symptoms improved with supportive care. Azathioprine was discontinued because of nausea and possible nonadherence, and he was discharged on a prednisone taper with outpatient rheumatology follow-up.<br /><br />The report emphasizes that lupus peritonitis is rare and is a diagnosis of exclusion. It can be difficult to recognize, especially in patients with multiple comorbidities or another autoimmune condition that obscures the picture. The authors highlight the importance of considering SLE in patients with unexplained ascites to allow timely diagnosis and appropriate treatment.

Asset Subtitle

Amina Islam

Meta Tag

Author List Aisha Shaikh, Alyssa Bren, Amina Islam, Andrew Alter, Danielle Cicka, Kelli King-Morris, Madeleine Yancy, Sarah Naids

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Lupus Peritonitis

Concept Cirrhotic Ascites

Concept Diagnosis of Exclusion

Concept Exudative Ascites

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis School of Medicine

Presenting Author Amina Islam

Track Adult

Keywords

systemic lupus erythematosus

lupus peritonitis

ascites

coronary artery disease

end-stage renal disease

IgG4-related disease

exudative ascites

dsDNA antibodies

low complement

cardiomyopathy

Systemic Lupus Erythematosus

Lupus Peritonitis

Cirrhotic Ascites

Diagnosis of Exclusion

Exudative Ascites