Recurrent Polyserositis as the Inaugural Manifestation of Systemic Lupus: A Case Report from the CHUD-Borgou, Parakou, Benin

Introduction: Systemic lupus (SL) is a systemic autoimmune disease with a particularly severe presentation in African populations. In tuberculosis-endemic regions of sub-Saharan Africa, its clinical overlap with extrapulmonary tuberculosis constitutes a major diagnostic pitfall, leading to harmful treatment delay. We report the case of an 18-year-old woman presenting with a severe, life-threatening, multi-organ inaugural form of SLE following an eleven-month diagnostic odyssey.
Case Report: An 18-year-old patient was admitted to the emergency department for cardiorespiratory failure and anasarca. She presented with malar rash, alopecia, Raynaud's phenomenon, polyarthritis, renal involvement (24-hour proteinuria of 1.139 g/day, hypoalbuminemia at 21.15 g/L), cardiac involvement (moderate-volume pericardial effusion without signs of poor tolerance), and pulmonary involvement (severe pulmonary hypertension). Her history revealed polyserositis eleven months earlier, mistakenly treated as tuberculosis despite a negative sputum smear. Immunological testing (antinuclear antibodies [ANA] 1:320, speckled pattern; positive anti-double-stranded DNA [anti-dsDNA] antibodies) confirmed the diagnosis of SL according to the 2019 EULAR/ACR classification criteria. Management included emergency pleural drainage and initiation of triple immunosuppressive therapy (bolus methylprednisolone, hydroxychloroquine, mycophenolate mofetil), with a favorable clinical course.
Conclusion: This case illustrates the dangerous clinical overlap between extrapulmonary tuberculosis and SLE in tuberculosis-endemic African regions, leading to harmful diagnostic delay. Any recurrent polyserositis in a young woman — especially when resistant to antituberculosis treatment — should prompt investigation for systemic autoimmune disease. A multidisciplinary approach and early, appropriate immunosuppression are critical determinants of prognosis.