The patient, a 49-year-old woman with known Felty's syndrome, presented with massive ascites, symmetric arthritis of the proximal and distal interphalangeal joints of both hands and feet, and back pain. Cytologic examination of the ascites fluid (by hematoxylin and eosin staining) showed multiple lupus erythematosus cells comprising neutrophil granulocytes with central phagocytized nuclear material (double arrow) and resulting peripheralized nuclei of the granulocytes (arrow). Mixed connective tissue disease with features of systemic lupus erythematosus and Felty's syndrome was diagnosed, and treatment with steroids and azathioprine was initiated. The presence of lupus erythematosus cells in ascites is an extremely rare finding. To our knowledge, only 1 similar case has been reported to date (Chou KT, Lee YC, Chen CW, Shih JF, Tung SM, Yang YT, et al. Lupus erythematosus [LE] cells in ascites: initial diagnosis of systemic lupus erythematosus by cytological examination: a case report. Clin Rheumatol 2007;26:1931–3). 1