When the lungs reveal the hidden lupus: A case of pulmonary vasculitis as the first manifestation of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease that can affect various organs, including the lungs. Pulmonary vasculitis is a rare but severe manifestation that may acutely reveal SLE. It results from immune-mediated inflammation of pulmonary vessels, potentially leading to severe hypoxemia, respiratory failure, and diffuse parenchymal involvement. We report the case of a 36-year-old woman who presented with pulmonary vasculitis as the first manifestation of SLE, which progressed to acute respiratory distress requiring mechanical ventilation, with diagnosis confirmed by specific immunological markers. Management included intravenous methylprednisolone pulses, followed by oral prednisone and hydroxychloroquine. This case highlights the importance of early recognition of severe pulmonary manifestations of lupus to prevent life-threatening complications.