Systemic lupus erythematosus presenting with massive ascites: a case report

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A 40-year old female was admitted to National Defense Medical College Hospital on March, 13, 1983 because of ascites of unknown cause.The patient had had several episodes of polyarthralgia since 1979 and leucopenia was pointed out at the time of regular check-up. She suffered from common cold in December 1982. From this time she began to notice gradual distention of the abdomen. In February 1983, ascites was pointed out at a nearby hospital, but the cause of her ascites was unknown.On the admission in March 1983, there was no laboratory findings to suggest the constrictivepericarditis, nephrotic syndrome or liver disease. Laboratory evaluation revealed hypergammaglobulinemia and hypocomplementemia with positive LE test, FANA and DNA-antibody (RIA). Renal biopsy demonstrated mesangial lupus nephritis. Culture of her ascites for fungi and bacteria was negative. The cytology was class II. At this time she was diagnosed as having lupus peritonitis.Immune complex (Clq-IC) of the serum and the peritoneal fluid was 2.0μg/ml and 6.1μg/ml, respectively. The complement (CH50) content of the peritoneal fluid was lower than that of the serum. FANA titre of the serum and the peritoneal fluid was 1:320 and 1:80, respectively. Furthermore, analyzing T cell subsets of the peritoneal fluid by Cytofluorograf Flow Cytometer, OKT 8+ T cells were significantly elevated.These immunological findings suggested immune complex mediated tissue injury, an evidence of local immune complex formation and the role of cytotoxic T cell in the development of lupus peritonitis.Her ascites comletely resolved after a high dose prednisolone therapy.
日本臨床免疫学会の論文

Systemic lupus erythematosus presenting with massive ascites: a case report

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