Subdural haematoma as the initial manifestation of systemic lupus erythematosus associated with severe pancytopenia

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect any organ or system, including the central nervous system (CNS). Cerebrovascular disease is included in its spectrum of manifestations, notable for its morbidity and mortality and associated disability. However, this presentation is very rare as an initial manifestation of SLE, particularly subdural haematoma. We present the case of a 57-year-old male patient who was admitted to a primary care centre with headache accompanied by alarm signs, documenting staggered subdural collections in the right frontal region together with a pontine intraparenchymal hemorrhage on the same side, in the context of severe pancytopenia. In the course of its evolution and complementary tests in the search for the etiology of pancytopenia, after excluding the most common causes, an autoimmune origin was concluded in the context of SLE with atypical clinical presentation.