An Uncommon Clinical Mystery: Systemic Lupus Erythematosus Masquerading as Aseptic Meningitis in a Male Patient

Systemic lupus erythematosus (SLE) is an intricate autoimmune disease characterized by its impact on various organ systems, presenting with a wide range of clinical manifestations such as hematologic, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, immunologic, cardiac, pleuropulmonary, and renal symptoms. Although its etiology is primarily autoimmune, various triggers, such as pregnancy, certain drugs, and infections, can result in "flares" with frequent relapses. Although more common in females, SLE is not uncommon in males, with a significant proportion experiencing a high disease burden. Over the years, many treatment modalities and approaches in modern medicine have evolved to combat this disease. However, it still poses a challenge to treating physicians due to the intricate elements in its pathogenesis. Further evidence-based studies are necessary to enhance our understanding of the disease. We describe the case of a 53-year-old man who presented with a three-day history of fever and a one-day history of altered sensorium. On evaluation, he was found to have pancytopenia and acute kidney injury. He was worked up for infectious and inflammatory causes. Investigations were strongly in favor of SLE and aseptic meningitis. We started him on pulse steroid therapy, following which he had substantial recovery. After one year, he presented with complaints of frothy urine, when lupus nephritis was diagnosed, and he was started on specific immunosuppressive agents. He has had no further episodes of relapse since then.