Chylous Ascites and Pleural Transudate: Rare Presentations in Systemic Lupus Erythematosus in Old Age

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with involvement of multiple organs. Various forms of serositis, including pleural effusion, pericardial effusion, and ascites, may be found during the course of SLE. Peritoneal involvement by ascites is common in the initial presentation of SLE. However, chylous ascites is uncommon in SLE patients. Here, we describe a 93-year-old female with initial presentation of chylous ascites during SLE flares. Marked distention and an ovoid shape of the abdomen were observed. Shifting dullness and central tympanic sounds were found on percussion. Rales were heard in bilateral breathing sounds, multiple oral ulcers appeared in the oral cavity, and chest images showed bilateral pleural effusion. Abdominal sonography revealed moderate ascites and pleural effusion. Neither organisms nor malignant cells were revealed in the culture or cytology of ascites and pleural effusion. The diagnosis of SLE was arrived at by positive antinuclear antibody (ANA), discoid rash, oral ulcers, serositis (pleural effusion and ascites), and proteinuria. The patient received intravenous methylprednisolone 250？mg/day for three days. The pleural effusion resolved dramatically after steroid therapy and abdominal distention related to ascites formation subsided obviously. 1. Introduction Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder. It can affect any part of the body, such as the skin, kidneys, joints, liver, lungs, nervous system, and even blood vessels [1]. The damage is thought to be the result of a type III hypersensitivity reaction when an antibody-immune complex attacks our own antigen. As the inflammation cascade starts, cell and tissue damage results. Its clinical course is unpredictable because any type of presentation may develop at any time. Its prevalence is more common in women than in men, especially in women of child-bearing age, and it is more often seen in those of non-European descent. In addition, the clinical course in men and old age is more difficult to recognize, due to vague and rare presentations. Various forms of serositis, including pleural effusion, pericardial effusion, and ascites, may be found in the course of SLE. Ascites and pleural effusion have been studied extensively. Sometimes, case reports present chylous pleural effusion. Peritoneal involvement by ascites is not common in the initial presentation of SLE [2]. In fact, ascites in SLE is said to occur only when complicated by nephritic syndrome, congestive cardiac failure, or hepatic cirrhosis [3, 4]. Even then,