Description Clinical manifestations of SLE in male patients tend to be more severe with a worse prognosis. Generally, SLE in male patients involves kidney and serological abnormalities such as hypocomplementemia and anti-dsDNA autoantibodies. In addition, cardiovascular complications are more common in men with SLE, which contributes to an overall increase in organ damage. Case illustration A 18-year-old male patient suffered from back pain 6 months ago. He complained of low urine output (urinating 3–4 times a day with a total output of approximately 400 mL), dyspnea, and swelling in both legs. Pericard effusion was discovered, and pericardiocentesis was performed. Physical examination showed the patient was hemodynamically stable. We found malar rash, rash in the plantar pedis and plantar manus also decreased vesicular sounds with rales in both lungs. Laboratory examination showed leukopenia, thrombocytopenia, hypoalbuminemia, hyperuricemia, and a glomerular filtration rate of 94 mL/min/1.73 m2. Urinalysis showed proteinuria, hematuria, and leukocyturia. Blood gas analysis found metabolic alkalosis. ANA IF test was positive for anti-Smith, anti-RNP-Smith, and anti-dsDNA antibodies. The patient was given methylprednisolone pulses dose (1000 mg/day) for 3 days, followed by methylprednisolone 125mg/12h for 3 days, 62.5mg/12h for the next 3 days and tapered-off to 8mg/day. The patient also received mycophenolic acid (500mg/8h), hydroxychloroquine (200mg/day) per oral, and Captopril 12.5mg/8h per oral during hospitalization. The patient showed clinical improvement and was discharged after 11 days. Subsequent follow-up at rheumatology policlinic showed the patient had improved both clinically and laboratory.

Conclusions The patient‘s condition in this case is consistent with the theory, where the patient is experiencing lupus nephritis and pericardial effusion. Establishing an accurate diagnosis of SLE in male patients is crucial. Early diagnosis leads to better outcomes.