Abstract

Unmasking Lupus in a Resource- Limited Setting: When Sepsis Wasn’t the Culprit: A Case Report

Author(s): Mark Paul Mayala*, Peter Shadrack Mabula, Genet Kifle, Nesar Ahmad Hamraz and Chrystina Russell

This case highlights the diagnostic challenge of systemic lupus erythematosus (SLE) in a resourcelimited rural setting where infectious diseases are commonly prioritized. A 16-year-old boy presented with prolonged fever, severe fatigue, generalized edema, and weakness, initially managed empirically for sepsis and tuberculosis without improvement. Multiple antibiotics and anti-TB treatment failed, and autoimmune workup was delayed due to cost constraints. Upon clinical deterioration, corticosteroids were initiated empirically with rapid improvement. Later, positive ANA and anti-SmD1 antibodies confirmed SLE. The case emphasizes the importance of clinical suspicion and adaptability in low-resource settings, where autoimmune diseases may go unrecognized. Timely corticosteroid use became both diagnostic and therapeutic. In resourceconstrained environments, clinical intuition and flexibility can be lifesaving when laboratory support is lacking, especially in cases of treatable but underdiagnosed conditions like lupus.