Evolving Systemic Lupus Erythematosus Manifesting as Severe Sepsis With Secondary Autoimmune Hemolytic Anemia: A Diagnostic Dilemma

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune condition with diverse clinical presentations, including complex hematologic and infectious complications. We report the case of a 23-year-old female who presented with high-grade fever, jaundice, and a lower leg ulcer. Initial findings of gram-negative bacteremia led to a diagnosis of sepsis; however, persistent severe anemia and positive immunologic markers (ANA 2+, low complement levels) confirmed underlying SLE with secondary Autoimmune Hemolytic Anemia (AIHA). This case highlights the challenges of diagnosing SLE when it mimics or coexists with severe sepsis, emphasizing the need for early recognition of AIHA to initiate life-saving immunosuppressive therapy.