Refractory ascites as the first presentation of systemic lupus erythematosus.

Serositis (peritonitis, pleuritis, and pericarditis) can be observed in approximately 13% of patients with systemic lupus erythematosus (SLE). However, peritoneal serositis presenting as painless massive ascites is extremely rare with only few cases been reported. Indeed, ascites in SLE has been reported to occur only when complicated by nephrotic syndrome, congestive cardiac failure, or portal hypertension. We describe herein a very unique case of SLE related serositis presenting with a massive refractory ascites, normal albumin, and absence of a clear autoimmune disorder or protein-losing enteropathy (PLE) at the time of her presentation, which only responded to a pulse course of corticosteroid. SLE was confirmed 2 years later.