Objective Systemic lupus erythematosus (SLE) can affect virtually any organ and can thus be a predisposing factor for secondary complicating conditions. The aim is to present a case of a severe multiorgan SLE complicated by tuberculosis in a young woman.

Methods A 42-year-old woman with a known history of SLE was referred for a rheumatological consultation due to deterioration of her general condition. Her medical history had started ten years earlier with thrombocytopenia in HELLP syndrome and preeclampsia in late pregnancy. Four years later she developed pancytopenia, with elevated anticardiolipin levels. Antiphospholipid syndrome and SLE were suspected and she was started on prednisone, azathioprine, and hydroxychloroquine. A year later she suffered an ischemic stroke and developed epilepsy as a sequela. After another three years, she suffered an ST-elevation myocardial infarction and underwent coronary intervention, and two years later, she had an identical episode. Echocardiography showed mitral regurgitation due to Libman-Sacks endocarditis. One year later she was hospitalized due to the development of pulmonary tuberculosis, was treated with antimycobacterial treatment, and dismissed after they were discontinued.

Results She had been lost to rheumatological follow-up for three years. At the visit, she complained of poor general condition. She had noticeable hyperpigmentation of the face and forehead. The remaining physical examination was unremarkable. Chest X-ray showed several infiltrates and hilar lymphadenopathy. Workup was scheduled, including sputum cultures, thorax CT, echocardiography, cardiological consultation, and rheumatology blood profile. Workup results confirmed an exacerbation of pulmonary tuberculosis. Antituberculotics were reintroduced. At the latest follow-up her primary disease and infectious complications remain under control.

Conclusions Systemic lupus erythematosus flares are serious and infrequently fatal. Discerning between them and secondary complications can be challenging, particularly if follow-up is inadequate.