Table 1: Case reports of ascites as the presenting feature of SLE.

 

Year/Author (reference)

Clinical Presentation

SAlba

AsAlbb

ANA

anti-dsDNA

C3

C4

Treatment

Outcome

Mier [14]

24yo F with abdominal pain and distention x1 month

NR

3.9 g/dL

NR

13% binding (normal 0-2%)

30 mg/dL

4 mg/dL

Prednisone 60 mg/day

Resolution in 10 days

Ishiguro [10]

52yo F with fever, rash, abdominal distention x6 months

2.8 g/dL

2.2 g/dL

1:1280

36 U/mL (radio-immunoassay, normal < 10 U/mL)

< 20 mg/dL

< 5 mg/dL

Prednisolone 50 mg, Methylprednisolone 1 g/day 3 days (repeated twice) followed by taper

Massive ascites resolved after pulse dose steroids

Hammoudeh [4]

27yo F with abdominal pain, n/v with new rash and joint pain

NR

Ascites Protein 4.8 g/dL

1:1280

1:20

51 mg/dL

10 mg/dL

Sulindac 400 mg/day, Chloroquine 500 mg/day

Discharged 1 week later with minimal symptoms

Weinstein [2]

33yo F with sharp peri-umbilical pain and increasing abdominal girth x1 week

2.7 g/dL

1.9 g/dL

pos

pos

23.7 mg/dL

7.9 mg/dL

Methyl-prednisolone + Cyclophosphamide

Discharged with minimal ascites and mild AKI

Ito [11]

77yo F with pancytopenia and worsening ascites and lower extremity edema x3 months

2.2 g/dL

2.3 g/dL

pos

71 U/mL

20.4 mg/dL

9.4 mg/dL

Prednisolone 60 mg/day, Methylprednisolone 0.5 g/day 3 days ( 2) tapered to 15 mg over by 2 months

Complicated by pneumonia, death

Trock [15]

80yo F with increasing abdominal girth and extremity edema over 3 weeks, found to have massive ascites and pericarditis

NR

NR

1:640

37 (crithidia assay, normal < 25)

62 mg/dL

13 mg/dL

Methylprednisolone 60 mg followed by prednisone 20 mg bid, AZA 100 mg/day, Hydroxychloroquine 400 mg/day

Resolution without symptoms by 4 weeks, but recurred on 2 year follow up

Forouhar-Graff [7]

18yo F with n/v, diarrhea, abdominal distention x4 weeks

2.9 g/dL

1.9 g/dL

1:5120

1:80

53 mg/dL

4 mg/dL

Methylprednisolone 250 mg 3 days, then 60 mg/day 4 weeks

Over the course of 18 months, was still steroid dependent and AZA was started given 2 relapses

Prasad [8]

26yo F with 2.5 months of abdominal distention and fever postpartum

2.5 g/dL

1.72 g/dL

pos

115 U/mL

44.9 mg/dL

6.85 mg/dL

Prednisolone 1 mg/kg; hydroxychloroquine maintenance

Ascites resolved by 4 weeks; in remission at 3 months follow-up

Pott Junior [16]

47yo F with increasing abdominal size x2 months and diffuse pain

2.5 g/dL

1.65 g/dL

1:160

neg

na

na

Prednisone 60 mg/day; chloroquine 250 mg/day

Ascites resolved and patient was asymptomatic at 3 months follow-up

Liu [18]

19yo M with abdominal pain/n/v x3 days

3.4 g/dL

NR

pos

pos

55 mg/dL

10mg/dL

Prednisone 60 mg/day; chloroquine 250 mg/day

Symptoms resolved at 3 months follow-up

Zhou [1]

39yo F with abdominal distention and pain x20 days

3.2 g/dL

NR

1:800

neg

 

anti-Sm pos

65 mg/dL

5 mg/dL

Methylprednisolone 40 mg/day, taper to 10 mg/day; 0.2 g/day hydroxychloroquine maintenance

Abdominal pain and distention improved by day 7, ascites resolved by 1 month

YO: Year Old; M: Male; F: Female; NR: Not Reported; n/v: Nausea and Vomiting; Neg: Negative; Pos: Positive; AZA: Azathioprine. aSalb,serum albumin; bAsAlb, ascites albumin