Clinical Spectrum and Multisystem Diversities in Systemic Lupus Erythematosus: A Case Series from a Tertiary Care Hospital
DOI:
https://doi.org/10.52206/jsmc.2026.16.1.1267Abstract
Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder characterized by multisystem involvement and unpredictable disease flares. The diversity of its clinical manifestations from mild cutaneous lesions to life-threatening organ dysfunction poses significant diagnostic and therapeutic challenges.
Objective: To describe six clinically diverse presentations of SLE highlighting diagnostic variability, management complexity, and the necessity of a multidisciplinary treatment approach.
Case Presentation: This case series includes six patients with atypical SLE manifestations managed at a tertiary-care teaching hospital. Diagnostic evaluation was based on clinical features, immunological markers, and laboratory investigations aligned with the 2019 EULAR/ACR classification criteria. Each patient’s management was tailored to disease severity and systemic involvement.
Results: The cases encompassed (1) polyarthritis with acute sensory-motor polyneuropathy, (2) autoimmune anemia of pregnancy with β-thalassemia minor, (3) vasculitis with pulmonary hypertension, (4) antiphospholipid-positive lupus with hepatosplenomegaly, (5) SLE-related thrombotic thrombocytopenic purpura, and (6) hepatic lupus with portal vein thrombosis. Immunosuppressive therapy—principally corticosteroids, hydroxychloroquine, rituximab, and plasmapheresis—was individualized for each patient. All demonstrated clinical improvement during 2–6 months of follow-up.
Conclusion: The heterogeneity of SLE demands high clinical suspicion and an integrated multidisciplinary approach. Early recognition of atypical patterns, prompt immunosuppressive therapy, and long-term monitoring can substantially improve patient outcomes.
Keywords: Autoimmune Disease, Multisystem Involvement, Polyneuropathy, Portal Vein Thrombosis, Pulmonary Hypertension, Systemic Lupus Erythematosus, Thrombotic Thrombocytopenic Purpura.
References
García-Carrasco M, Mendoza Pinto C, Solís Poblano JC. Systemic lupus erythematosus. In: Anaya JM, Shoenfeld Y, Rojas-Villarraga A, et al., editors. Autoimmunity: From Bench to Bedside [Internet]. Bogotá (Colombia): El Rosario University Press; 2013 Jul 18. Chapter 25. https://www.ncbi.nlm.nih.gov/books/NBK459474/
Ameer MA, Chaudhry H, Mushtaq J, Khan OS, Babar M, Hashim T, et al. An overview of systemic lupus erythematosus (SLE) pathogenesis, classification, and management. Cureus. 2022 Oct 15;14(10):e30330. https://doi.org/10.7759/cureus.30330
Weckerle CE, Niewold TB. The unexplained female predominance of systemic lupus erythematosus: clues from genetic and cytokine studies. Clin Rev Allergy Immunol. 2011 Feb;40(1):42–9. https://doi.org/10.1007/s12016-009-8192-4
Piovani D, Brunetta E, Bonovas S. UV radiation and air pollution as drivers of major autoimmune conditions. Environ Res. 2023 May 1;224:115449. https://doi.org/10.1016/j.envres.2023.115449
Lopes DM, McMahon SB. Ultraviolet radiation on the skin: a painful experience? CNS Neurosci Ther. 2016 Feb;22(2):118–26. https://doi.org/10.1111/cns.12444
Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD. Manifestations of systemic lupus erythematosus. Maedica (Bucur). 2011 Oct;6(4):330–6. PMID: 22879850.
Kernder A, Richter JG, Fischer-Betz R, Winkler-Rohlfing B, Brinks R, Aringer M, et al. Delayed diagnosis adversely affects outcome in systemic lupus erythematosus: cross sectional analysis of the LuLa cohort. Lupus. 2021 Mar;30(3):431–8.
https://doi.org/10.1177/0961203320983445
Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey?Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019 Sep;71(9):1400–12. https://doi.org/10.1002/art.40930
De Souza JM, Trevisan TJ, Sepresse SR, Londe AC, França Júnior MC, Appenzeller S. Peripheral neuropathy in systemic autoimmune rheumatic diseases—diagnosis and treatment. Pharmaceuticals (Basel). 2023 Apr 14;16(4):587. https://doi.org/10.3390/ph16040587
Narváez J, Ríos-Rodriguez V, de la Fuente D, Estrada P, López-Vives L, Gómez-Vaquero C, Nolla JM. Rituximab therapy in refractory neuropsychiatric lupus: current clinical evidence. Semin Arthritis Rheum. 2011 Dec;41(3):364–72. https://doi.org/10.1016/j.semarthrit.2011.06.004
Hanly JG, Urowitz MB, Su L, Bae SC, Gordon C, Wallace DJ, et al. Prospective analysis of neuropsychiatric events in an international disease inception cohort of patients with systemic lupus erythematosus. Ann Rheum Dis. 2010 Mar;69(3):529–35. https://doi.org/10.1136/ard.2008.106351
Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, et al. Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med. 2015 Aug 4;163(3):153–63. https://doi.org/10.7326/M14-2235
Khangoora V, Bernstein EJ, King CS, Shlobin OA. Connective tissue disease–associated pulmonary hypertension: a comprehensive review. Pulm Circ. 2023 Dec 11;13(4):e12276. https://doi.org/10.1002/pul2.12276
Bustamante JG, Goyal A, Rout P, Singhal M. Antiphospholipid syndrome [Updated 2024 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. https://www.ncbi.nlm.nih.gov/books/NBK430980/
Jain R, Chartash E, Susin M, Furie R. Systemic lupus erythematosus complicated by thrombotic microangiopathy. Semin Arthritis Rheum. 1994 Dec;24(3):173–82. https://doi.org/10.1016/0049-0172(94)90073-6
Sukumar S, Lämmle B, Cataland SR. Thrombotic thrombocytopenic purpura: pathophysiology, diagnosis, and management. J Clin Med. 2021 Feb 2;10(3):536. https://doi.org/10.3390/jcm10030536
Praharaj DL, Mallick B, Nath P, Panigrahi SC, Padhan P, Sahu N. Unusual presentation of systemic lupus erythematosus in a young male: a case report. J Clin Exp Hepatol. 2021 Mar–Apr;11(2):264–9. https://doi.org/10.1016/j.jceh.2020.05.009
Beisel C, Weiler-Normann C, Teufel A, Lohse AW. Association of autoimmune hepatitis and systemic lupus erythematodes: a case series and review of the literature. World J Gastroenterol. 2014 Sep 21;20(35):12662–7. https://doi.org/10.3748/wjg.v20.i35.12662
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