An Unusual Initial Presentation of Systemic Lupus Erythematosus with Psychosis and Bleeding: A Case Report

The patient reported a history of alopecia and intermittent low-grade fever for 2 months, with no joint pain, skin rash, oral ulcers, seizures, Raynaud's phenomenon, previous abortion, cough, breathlessness, dysuria, jaundice, abdominal pain, weight loss, or loss of consciousness.She also had a history of heavy menstrual bleeding for the past 2 months.On examination, she had pallor and nonscarring alopecia, without petechiae or purpura and no active nasal bleed.She appeared conscious and apathetic, with decreased verbal output, normal reflexes, no neck stiffness, and bilateral plantar flexors.Laboratory investigations revealed microcytic hypochromic anemia and severe thrombocytopenia (Table 1), along with elevated inflammatory markers.Liver and kidney function tests were normal.After ruling out B12 deficiency and infectious causes