Abstract
BACKGROUND: Systemic lupus erythematosus can present with diverse and often misleading clinical manifestations due to symptom overlap with other medical conditions. Misinterpretation of its presentation may result in delayed diagnosis and hinder the timely initiation of standard treatment. CASE PRESENTATION: A 28-year-old Black Ethiopian female patient presented with upper gastrointestinal bleeding, skin rashes, easy fatigability, psychological abnormalities, and pneumonia. Physical examination revealed blood pressure of 90/55 mmHg, pulse rate of 124 beats per minute, which was weak but regular, respiratory rate of 26 breaths per minute, febrile with body temperature of 38.5 °C, and she was desaturating with oxygen saturation of 84% with room air, later improved to 94% with a face mask at a flow rate of 8 L per minute. Her conjunctivae were pale with blood actively oozing from the gums, with tiny, round, whitish lesions on buccal mucosae. There was coarse crepitation on the bilateral infrascapular area of the lungs. This was a case of systemic lupus erythematosus, presenting with upper gastrointestinal bleeding and treated with disease-modifying agents, supportive care, and levothyroxine for subclinical hypothyroidism, as was confirmed from laboratory investigation results. Her condition improved completely following the treatment. CONCLUSION: Although systemic lupus erythematosus typically involves multiple organ systems, atypical features-such as upper gastrointestinal bleeding and recurrent pneumonia-can obscure the diagnosis and delay the initiation of appropriate treatment. In this case, despite the late start of therapy, the patient achieved full recovery. This case highlights the importance of recognizing rare manifestations of relatively common diseases and evaluating for coexisting conditions, such as subclinical hypothyroidism, which would influence disease activity, treatment response, and overall prognosis.