Diffuse Alveolar Haemorrhage as the Initial Presentation of Systemic Lupus Erythematosus: A Case Report from South Africa

Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening pulmonary complication of systemic lupus erythematosus (SLE), with high mortality if unrecognized. It is a rare initial manifestation of SLE and presents diagnostic challenges, particularly in tuberculosis-endemic, resource-limited settings. We describe a 47-year-old female healthcare worker with no prior medical history who presented to a regional hospital in Durban, South Africa, with acute respiratory distress and massive haemoptysis following a week of coughing. After intensive investigations, DAH secondary to undiagnosed SLE was confirmed. This case highlights DAH as a rare but fatal initial presentation of SLE. In patients with massive haemoptysis where infection and malignancy are excluded, autoimmune causes must be considered. Early recognition, immunosuppression, and multidisciplinary care are essential, especially in resource-constrained, TB-endemic regions.