Systemic Lupus Erythematosus Presenting With Hemoptysis at Onset in an Elderly Male

Systemic lupus erythematosus (SLE) is a connective tissue disorder with an unknown cause that primarily impacts women of reproductive age. We present a case of a new-onset elderly male SLE with positive anti-nuclear antibodies (ANAs) and clinical presentations including hemoptysis, fatigue, weight loss, multiple skin and mucosal lesions, and intractable pyrexia. The European League Against Rheumatism guidelines and comprehensive evaluations were used to establish a diagnosis of SLE. The prevalence of SLE in males is lower compared to women, often presenting with negative ANA, which makes diagnosis challenging. An unusual and striking feature in this case was hemoptysis as the initial presenting symptom, a rare manifestation that highlights the need for heightened suspicion. Thus, having a high degree of suspicion as a primary care doctor helps in early diagnosis, improves treatment outcomes, and leads to a better quality of life.