Clinical Spectrum and Multisystem Diversities in Systemic Lupus Erythematosus: A Case Series from a Tertiary Care Hospital

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder characterized by multisystem involvement and unpredictable disease flares. The diversity of its clinical manifestations from mild cutaneous lesions to life-threatening organ dysfunction poses significant diagnostic and therapeutic challenges. Objective: To describe six clinically diverse presentations of SLE highlighting diagnostic variability, management complexity, and the necessity of a multidisciplinary treatment approach. Case Presentation: This case series includes six patients with atypical SLE manifestations managed at a tertiary-care teaching hospital. Diagnostic evaluation was based on clinical features, immunological markers, and laboratory investigations aligned with the 2019 EULAR/ACR classification criteria. Each patient’s management was tailored to disease severity and systemic involvement. Results: The cases encompassed (1) polyarthritis with acute sensory-motor polyneuropathy, (2) autoimmune anemia of pregnancy with β-thalassemia minor, (3) vasculitis with pulmonary hypertension, (4) antiphospholipid-positive lupus with hepatosplenomegaly, (5) SLE-related thrombotic thrombocytopenic purpura, and (6) hepatic lupus with portal vein thrombosis. Immunosuppressive therapy—principally corticosteroids, hydroxychloroquine, rituximab, and plasmapheresis—was individualized for each patient. All demonstrated clinical improvement during 2–6 months of follow-up. Conclusion: The heterogeneity of SLE demands high clinical suspicion and an integrated multidisciplinary approach. Early recognition of atypical patterns, prompt immunosuppressive therapy, and long-term monitoring can substantially improve patient outcomes. Keywords: Autoimmune Disease, Multisystem Involvement, Polyneuropathy, Portal Vein Thrombosis, Pulmonary Hypertension, Systemic Lupus Erythematosus, Thrombotic Thrombocytopenic Purpura.