Refractory Ascites in a Patient with Systemic Lupus Erythematosus (SLE)

Patient selection: systemic lupus erythematosus

Clinical features:

(1) ascites, which may be chylous

(2) variable pleural and/or pericardial effusion

(3) variable mesenteric vasculitis and/or lupus nephritis

Ascites may be the presenting finding for SLE or it can occur with long-standing disease.

Laboratory features:

(1) elevation in serum CA125

(2) elevated cytokines in the ascites fluid

The diagnosis requires exclusion of other causes of ascites and portal hypertension (cirrhosis, etc).

Intraperitoneal dexamethasone or other corticosteroid can reduce the ascites.