Description Coronavirus disease 2019 (COVID-19) pandemic, had posed a huge impact among patients with deranged or dysregulated immune systems, these include autoimmune rheumatic diseases, specifically lupus and Human Immune deficiency Virus or Acquired Immune Deficiency Syndrome (HIV-AIDS). These subsets of patients, eg. SLE and People living with HIV (PLWH) are unique populations considering the risk for them of contracting COVID-19 infection and its outcomes. Here, we report a rare case of a 22-year-old Filipino male, who was diagnosed to have SLE pre-pandemic. His presentations included progressive easy bruisability with persistent bicytopenia (anemia and thrombocytopenia), malaise, arthralgia and ill-defined flat, non -pruritic, erythematous lesions on his legs and dry cough. On work up he was found to have interstitial lung disease, high titers ANA and positive anti-dsDNA. He was given prednisone, hydroxychloroquine and mycophenolate moefetil which offered significant improvement. He was lost follow up until pandemic set in. He experienced crampy abdominal pain, rashes on his legs, weight loss, diffuse alopecia, low grade fever and bicytopenia. Work up revealed positive HIV test, low CD4 count, and positive for RTPCR for Covid. Neoplastic process was ruled out. Given his condition, his antimalarial and mycophenolate were temporarily held. He was managed according to COVID 19 guidelines and eventually referred to treatment hub for HIV-AIDS therapy.

Conclusions This case illustrates the unfathomable relationship of infections and immune system. Identifying the clinical symptoms described as the presenting signs of a specific infection or a flare of lupus or one of the HIV associated clinical syndromes has remained a challenge for clinicians. A high index of suspicion must be kept in mind for appropriate and timely diagnosis. Management options must be tailored for the patient’s best outcomes.