Infectious facade of autoimmunity: when SLE masquerades as tuberculosis

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterised by widespread inflammation affecting multiple organ systems. Its varied clinical manifestations often complicate diagnosis, as it can closely mimic other conditions, particularly infectious diseases such as tuberculosis. This case report describes a woman in her early 20s initially suspected of having disseminated tuberculosis and treated accordingly due to overlapping symptoms, including fever, night sweats, lymphadenopathy and bilateral exudative pleural effusion. Subsequent evaluation, however, confirmed a diagnosis of SLE based on clinical criteria and positive autoantibody results. The patient also presented with anaemia of chronic disease and elevated inflammatory markers. This case highlights the diagnostic difficulty of differentiating SLE from tuberculosis, particularly in regions with high tuberculosis prevalence. Comprehensive physical examination, thorough evaluation and consideration of autoimmune disorders are essential in such cases to ensure accurate diagnosis, guide appropriate treatment and prevent severe complications.