Tukeni Kedir Negesso, Woyimo Tamirat Godebo, Dekema Ramadan Jemal, Bezabih Kidus Tesfaye, Gebremichael Ermias Habte, Kebede Merid Lemma, Asefa Elsah Tegene
Jimma University, Jimma, Ethiopia.
J Med Case Rep. 2025 Aug 5;19(1):391. doi: 10.1186/s13256-025-05419-4.
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.
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.
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.
系统性红斑狼疮可因与其他疾病症状重叠而出现多样且常具误导性的临床表现。对其表现的误解可能导致诊断延迟并阻碍标准治疗的及时启动。
一名28岁的埃塞俄比亚黑人女性患者出现上消化道出血、皮疹、易疲劳、心理异常和肺炎。体格检查显示血压为90/55 mmHg，脉搏率为每分钟124次，微弱但规律，呼吸频率为每分钟26次，发热，体温38.5℃，在室内空气中氧饱和度降至84%，后通过每分钟8升流速的面罩吸氧改善至94%。她的结膜苍白，牙龈有活动性渗血，颊黏膜有微小的圆形白色病变。双下肩胛区肺部有粗湿啰音。这是一例系统性红斑狼疮患者，伴有上消化道出血，接受了改善病情的药物、支持治疗以及左甲状腺素治疗亚临床甲状腺功能减退，实验室检查结果证实了诊断。治疗后她的病情完全好转。
尽管系统性红斑狼疮通常累及多个器官系统，但非典型特征，如上消化道出血和反复肺炎，可能会掩盖诊断并延迟适当治疗的启动。在本病例中，尽管治疗开始较晚，但患者仍实现了完全康复。该病例凸显了认识相对常见疾病的罕见表现以及评估共存疾病（如亚临床甲状腺功能减退）的重要性，这些疾病会影响疾病活动、治疗反应和总体预后。
