SLE presenting as multiple hemorrhagic complications

Area of Science:

• Rheumatology
• Hematology
• Neurology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations.
• Hemorrhagic complications can occur in SLE, but bilateral adrenal hemorrhage is rare, especially without antiphospholipid syndrome (APS).

Observation:

• A 24-year-old female with hereditary spastic paraplegia presented with headache, abdominal pain, vomiting, pallor, icterus, and splenomegaly.
• Diagnostic workup revealed hemolytic anemia, thrombocytopenia, and extensive hemorrhages including bilateral adrenal, subdural, scalp, and orbital sites.

Findings:

• The patient's symptoms and laboratory findings were attributed to systemic lupus erythematosus (SLE).
• Antiphospholipid syndrome (APS) antibodies were notably negative, making the bilateral adrenal hemorrhage a rare occurrence in this SLE patient.
• The constellation of findings included hemolytic anemia, thrombocytopenia, and multiple hemorrhages.

Implications:

• This case underscores the potential for rare and severe hemorrhagic manifestations in SLE, even in the absence of APS.
• It emphasizes the importance of considering SLE in patients presenting with unexplained bleeding, including adrenal hemorrhage.
• The findings contribute to understanding the spectrum of SLE complications and their management.