Unusual Case of Systemic Lupus Erythematosus (SLE) With Middle-Age Onset and Atypical Multisystem Involvement Middle-Age Onset SLE With Multisystem Involvement

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder predominantly affecting young females, with middle-age onset in males being a rare occurrence. Late-onset SLE can present with atypical multisystem involvement, complicating diagnosis and management.
Objective: To report an unusual case of SLE in a middle-aged male with multisystem complications, including lupus nephritis and pulmonary hypertension.
Methods: A 52-year-old male with dyspnea, chest pain, and lower extremity edema underwent comprehensive clinical evaluation. Laboratory tests included complete blood count, renal function tests, 24-hour urinary protein, and serological markers (ANA, anti-dsDNA). Imaging studies included echocardiography and high-resolution CT. Renal biopsy confirmed Class IV lupus nephritis. The patient received high-dose corticosteroids, hydroxychloroquine, and mycophenolate mofetil, with supportive management for pulmonary hypertension.
Results: The patient’s 24-hour proteinuria reduced from 4.2 g/day to 1.2 g/day. Pulmonary artery pressure improved from 35 mmHg to 30 mmHg after four weeks. Pleural effusions resolved completely, and renal function stabilized (creatinine from 1.9 mg/dL to 1.3 mg/dL).
Conclusion: This rare presentation of late-onset SLE in a male underscore the need for comprehensive evaluation and early intervention to prevent severe complications.