Male Systemic Lupus Erythematosus: A Rare Case of Multisystem Involvement.

Abstract

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations. Although SLE predominantly affects women, male patients may present atypically, leading to diagnostic challenges and delays in treatment. Neuropsychiatric involvement and lupus nephritis represent severe manifestations associated with increased morbidity.

Case presentation: A 31-year-old man presented with fatigue, joint pain, fever, and a photosensitive skin rash. Laboratory investigations showed positive antinuclear antibodies and elevated anti-double-stranded DNA levels. Brain MRI demonstrated scattered T2-weighted and FLAIR hyperintensities suggestive of central nervous system vasculitis, while renal biopsy confirmed class IV lupus nephritis. The patient was treated with corticosteroids, hydroxychloroquine, and mycophenolate mofetil. Follow-up MRI and MRA performed after three weeks showed partial resolution of white matter lesions with stable vasculature. Clinical symptoms improved, and renal function stabilised.

Conclusion: This case highlights the importance of considering neuropsychiatric SLE in male patients presenting with neurological symptoms and multisystem involvement. MRI and MRA can play an important role in detecting central nervous system involvement and monitoring treatment response, while early recognition and prompt treatment may help prevent irreversible neurological complications.