SHM Converge Scientific Abstract ePoster Gallery-Hidden in Plain Sight: A Story of an Undiagnosed Systemic Lupus Erythematosus With a Rare Clinical Presentation

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This case report describes a 32-year-old woman who presented with several weeks of progressive abdominal distention, abdominal pain, nausea, and vomiting. She also had chronic inflammatory joint symptoms, hair loss, dry eyes and mouth, Raynaud’s phenomenon, anemia, proteinuria, and acute kidney injury. On exam, she had generalized abdominal tenderness and a fluid wave consistent with ascites. Diagnostic paracentesis showed a low SAAG (0.6), suggesting exudative ascites. After rheumatology consultation, she was treated with IV methylprednisolone, which led to marked improvement in her ascites and other symptoms. She was discharged on hydroxychloroquine with outpatient follow-up.<br /><br />The report highlights systemic lupus erythematosus (SLE) as a multisystem autoimmune disease caused by loss of self-tolerance and characterized by varied clinical manifestations. While classic SLE features include fatigue, fever, malar rash, and arthralgia, this patient’s initial presentation was atypical. Her ascites was attributed to lupus serositis, a rare diagnosis of exclusion.<br /><br />Ascites occurs in only about 10% of patients with SLE and may result from peritoneal serositis, protein-losing enteropathy, nephrotic syndrome, or constrictive pericarditis. Peritoneal involvement is especially uncommon compared with pleural or pericardial serositis. The case emphasizes that unusual presentations can delay diagnosis if clinicians do not take a detailed history and maintain a broad differential.<br /><br />The main lesson is that unexplained ascites, especially when accompanied by other autoimmune symptoms, should prompt consideration of SLE even though ascites is not part of formal classification criteria. Early recognition can prevent diagnostic delay and improve outcomes.

Asset Subtitle

Ayotunde I. Buremoh

Meta Tag

Author List Ayotunde I. Buremoh, Brianna Smith, Mylene E. Vista, Saira Akhtar, Yuqing Wang

Category Clinical Vignettes

Concept Differential Diagnosis

Concept Cirrhotic Ascites

Concept Systemic Lupus Erythematosus

Concept Lupus Serositis

Concept Diagnosis of Exclusion

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center, Wakefield, New York

Presenting Author Ayotunde I. Buremoh

Track Adult

Keywords

systemic lupus erythematosus

SLE

ascites

lupus serositis

autoimmune disease

low SAAG

proteinuria

acute kidney injury

Raynaud phenomenon

hydroxychloroquine

Differential Diagnosis

Cirrhotic Ascites

Systemic Lupus Erythematosus

Lupus Serositis

Diagnosis of Exclusion