A challenging diagnosis in a male presented with ascites: Pseudo-pseudo Meigs syndrome and systemic lupus erythematosus

Gastrointestinal involvement as an initial presentation of systemic lupus erythematosus (SLE) is seen uncommonly. Among such presentations, ascites is an extremely rare clinical condition that requires extensive diagnostic investigation for nephrotic syndrome, tuberculosis, congestive heart failure, constructive pericarditis, and malignancy besides of SLE-related conditions such as lupus peritonitis, protein losing enteropathy, and pseudo-pseudo Meigs syndrome (PPMS). PPMS is still a debatable clinical description, characterized by ascites, elevated CA-125 levels, and absence of malignancy in an SLE patient. Notably, the clinician should keep in mind that all these possibilities could be the anchor manifestation of SLE as well. Therefore, definitive diagnosis might be challenging in case of ascites in an SLE patient. Herein, we aimed to share the difficulties from the first presentation to the definitive diagnosis in a patient with PPMS in the light of similar cases in the literature.