Recurrent Ischemic Strokes in a Young Female: An Atypical Initial Presentation of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs, but recurrent ischemic strokes as the first presentation are very rare. We report the case of a 35-year-old woman who presented with sudden loss of consciousness and right-sided weakness, with a history of multiple previous strokes of unknown cause. Brain magnetic resonance imaging (MRI) revealed multifocal subacute ischemia with hemorrhagic transformation, while laboratory findings showed thrombocytopenia, anemia, raised erythrocyte sedimentation rate (ESR), impaired renal function, and a positive antinuclear antibody (ANA) test, confirming the diagnosis of SLE with neuropsychiatric involvement. She was treated with intravenous steroids, antibiotics, and supportive care, with gradual clinical improvement. This case highlights the importance of considering autoimmune diseases like SLE in young patients with unexplained recurrent strokes, as early diagnosis and immunosuppressive therapy can prevent further complications and improve outcomes.