Case Report: An Unusual Cause of Massive Ascites

Ascites as the initial presentation of SLE is uncommon, especially massive ascites. Lupus peritonitis, the underlying mechanism, is thought to result from immune complex deposition and complement activation leading to peritoneal inflammation and exudative effusion. In this patient, the absence of typical features such as rash, arthritis, or haematological abnormalities initially obscured the diagnosis. This case illustrates how SLE can present insidiously and emphasizes the need for thorough autoimmune evaluation in unexplained exudative ascites once hepatic, cardiac, malignant, and infectious causes have been excluded. The rapid response to corticosteroid therapy underscores the importance of early recognition and immunosuppressive treatment to prevent complications.