Incidental presence of lupus erythematosus cells in ascitic fluid cytology as a clue in diagnosing systemic lupus erythematosus

Abstract A 23-year-old female patient presented with a history of fever, abdominal pain and breathlessness for the preceding 7 days. General physical examination revealed pallor and abdominal examination revealed tenderness all over the abdomen. empirical intravenous revealed moderate anaemia, lymphopenia, thrombocytopenia, hepatic dysfunction and acute kidney injury. Ultrasonography of the abdomen revealed hepatomegaly with moderate ascites. She was provisionally diagnosed to have tropical fever and was started on intravenous empirical antibiotics. Later, patient symptoms worsened. Diagnostic paracentesis was done, and ascitic fluid cytology incidentally revealed lupus erythematosus (LE) cells. This prompted us to investigate for systemic lupus erythematosus (SLE). Indirect immunofluorescence antinuclear antibody test revealed cytoplasmic fine-speckled pattern. The patient was started on treatment with immunosuppressants. She improved symptomatically and was discharged after 2 weeks of admission. The present case highlights the incidental presence of LE cells in ascitic fluid cytology which had given clue to the diagnosis of SLE.