Pleural Effusion and Neuropsychiatric Involvement in a Patient with SLE: A Report from a Resource-Limited,...

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse clinical manifestations that may mimic infectious conditions, particularly in tuberculosis-endemic regions. Pleural effusion and respiratory symptoms are often attributed to tuberculosis, leading to delayed recognition of autoimmune disease. Neuropsychiatric involvement represents a severe manifestation that may be under recognized in low-resource settings where access to specialized investigations is limited.

We report a 19-year-old Somali female who presented with a three-month history of progressive symmetrical polyarthritis, malar rash, and discoid lesions. She subsequently developed respiratory symptoms and bilateral pleural effusion. Despite negative GeneXpert testing, she was initially treated for tuberculosis due to high regional prevalence. After failing to improve and developing neuropsychiatric symptoms (hallucinations, agitation, and a seizure), she was referred to a tertiary center. Immunological testing confirmed Systemic Lupus Erythematosus (SLE) with positive ANA, anti-ds DNA, and SS-A/Ro antibodies. Treatment with high-dose corticosteroids, mycophenolate mofetil, and hydroxychloroquine led to significant clinical recovery.

In resource-limited, TB-endemic settings, SLE can be easily misdiagnosed. Clinicians must maintain a high index of suspicion for autoimmune diseases when patients with unexplained serositis or neuropsychiatric symptoms fail to respond to empirical TB therapy.