Diagnostic and Therapeutic Challenge in a Case with Simultaneous Onset of Systemic Lupus Erythematosus and Severe Pulmonary Infection

Cristina Criveanu^(1,3,*), Carmen Marilena Dumitru⁽²⁾, Alesandra Florescu^(1,3), Rasha Ionela Ramoiu-Shehada⁽³⁾, Ana Cojocaru⁽³⁾, Paulina Lucia Ciurea⁽¹⁾

1) Department of Rheumatology, University of Medicine and Pharmacy, Craiova, Romania
2) Medical Center Medixara Vital Craiova, Romania
3)Department of Rheumatology, Emergency County Hospital Craiova, Romania

Introduction: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with varied clinical manifestations. The concurrent onset of SLE with a severe infection is rare and represents a diagnostic and therapeutic challenge, requiring a multidisciplinary approach.
Case report: We present the case of a 50-year-old patient, known to have long-standing epilepsy and early menopause, who presented with inflammatory joint pain, diffuse alopecia, asthenia and evening fever. Investigations revealed pancytopenia, hypocomplementemia, positive ANA profile, positive direct Coombs test. Pulmonary imaging revealed multiple areas of ground-glass condensation and hydroaeric abscesses, and microbiological examination isolated Pseudomonas aeruginosa and Candida spp. The patient received complex treatment, including pulse corticosteroid therapy, broad-spectrum antibiotics, antifungals, hematological support and oxygen therapy, with careful monitoring of hematological and imaging evolution. The evolution was favorable, with regression of lung lesions and improvement of general condition. Subsequently, due to non-compliance, the patient presented relapses of SLE, being stabilized and proposed for biological therapy with anifrolumab.
Conclusions: The simultaneous onset of SLE and a severe pulmonary infection requires rapid recognition and multidisciplinary management. Careful monitoring, patient education and modern therapeutic options, including biological therapy, can prevent complications and optimize disease control.

Keywords: systemic lupus erythematosus, concurrent onset, severe pulmonary infection, anifrolumab, pancytopenia, multidisciplinary management

Corresponding author(s): Cristina Criveanu, Department of Rheumatology, University of Medicine and Pharmacy, Craiova, Romania; email: cristina.criveanu@umfcv.ro