B53-17 Rapid Onset Multi-System Organ Failure in New Diagnosis of Systemic Lupus Erythematosus

Abstract Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease that can lead to life-threatening multisystem organ failure. SLE admissions common to ICU settings include infections, neuropsychiatric complications, and renal failure. Rarely, patients present with rapid multisystem organ failure. We describe the case of a 32-year-old female who presented with acute onset concurrent glomerulonephritis, myopericarditis, and diffuse alveolar hemorrhage (DAH) with biopsy and serologies consistent with SLE. Case A 32-year-old female presented with painful unilateral periorbital swelling. At prior healthcare visits for vague gastrointestinal symptoms, workup demonstrated leukopenia, thrombocytopenia, trace hematuria, plus normal hemoglobin and troponin levels. Chest XR and CT angiogram chest/abdomen/pelvis were negative for thrombosis and cardiac pathology though did show mild axillary lymphadenopathy and possible colitis. Subsequent endoscopy and colonoscopy revealed chronic gastritis. In our emergency room two months later, she was tachycardic and hypertensive with narrow pulse pressure, delayed capillary refill, and jugular venous distention. Echocardiography identified a large pericardial effusion, evidence of tamponade physiology, and reduced ejection fraction (25%), prompting pericardiocentesis and ICU admission. Labs revealed moderate troponin elevation, decreased C3 and C4 levels, and severe renal injury. A renal biopsy demonstrated class IV lupus nephritis, with serologies confirming elevated anti-nuclear and anti-dsDNA antibody titers. Renal and rheumatology consultants recommended initiating renal replacement therapy (RRT) with pulse dose steroids, followed by cyclophosphamide. Due to her tenuous hemodynamics related to the pericardial effusion and new heart failure, she was managed with continuous RRT for several days. She subsequently developed acute respiratory failure requiring intubation with imaging suggestive of, and bronchoscopy confirming, DAH. Plasma exchange was initiated along with another course of pulse dose steroids. Discussion Although SLE is known to elicit immune-mediated effects across organ systems, this case highlights the rarity of rapid onset and concurrent renal, cardiac, and pulmonary complications. SLE associated myocarditis is an uncommon complication of SLE and can present subtly, ranging from sinus tachycardia to hypervolemia. DAH is a very rare complication of SLE, and its full pathogenesis is unknown. Further, DAH developing after initial treatment with pulse dose methylprednisolone and cyclophosphamide is exceedingly rare. This patient presented with three life-threatening complications of SLE, indicating a high disease burden. Just two months prior, she had unremarkable labs despite multiple symptoms that were eventually explained by her new SLE diagnosis. This case emphasizes the importance of high clinical suspicion for multiorgan involvement and the need for prompt treatment in critically ill patients with SLE. This abstract is funded by: None