Asma Qureshi, Mahaveer Maheshwari, Aasiya Shahbaz Sakarwala, Umaya Memon, Vishan Das, Mumtaz Ali Lakho, Sandesh Kumar, Abdul Ghafoor, Siddhant Kumar Yadav
We report a 15-year-old with a 3-year history of polyarthritis, unexplained seizures, and pulmonary tuberculosis who presented with acute neuropsychiatric decline, fever, and thrombocytopenia. Diagnostic workup confirmed systemic lupus erythematosus with triple-positive antiphospholipid antibodies. Imaging revealed bilateral middle cerebral artery thrombosis, meeting criteria for catastrophic antiphospholipid syndrome triggered by active tuberculosis. Prompt initiation of corticosteroids, anticoagulation, and immunosuppression was critical to achieving clinical stabilization.