The major presenting manifestations of systemic lupus erythematosus (SLE) in Korea are known to be cutaneous manifestations, arthritis, nephritis, and fever. The ascites due to peritoneal involvement in SLE is quite common. However, it is unusual for massive ascites to be major presenting manifestations of SLE. In this report, we describe a case of SLE patient whose disease manifested as intractable ascites. This illustrates an unusual presentation and natural history of a complex autoimmune disease.