Naimo Awil Dahir, Abdisalam Ismail Hassan, Abdinasir Mohamed Elmi, Mahad Sadik Mukhtar, Jama Farah Abdillahi, Abdirahman Mohamed Hassan Direi, Abdullahi Ali Roble, Nadira Mohamed Ali, Ikran Abdirahman Yusuf, Ahmed Muhammad Bashir, Balqiz Mohamed Kulle, Abdullahi Osman Mohamed, Said Abdi Mohamed
The coexistence of SPE, CVST, and ICH in SLE represents a rare but life-threatening scenario. Early recognition, prompt multimodal imaging, and coordinated multidisciplinary management are crucial for improving outcomes in high-risk patients.
BACKGROUND: Septic pulmonary embolism (SPE) is a rare but potentially life-threatening complication of systemic infection. Patients with systemic lupus erythematosus (SLE) are particularly vulnerable due to immune dysregulation, chronic inflammation, and a prothrombotic state. The concurrent occurrence of SPE, cerebral venous sinus thrombosis (CVST), and intracerebral hemorrhage (ICH) in an SLE patient is exceptionally uncommon and poses major diagnostic and therapeutic challenges.
CASE PRESENTATION: We report a 30-year-old woman with known SLE and lupus nephritis, receiving irregular immunosuppressive therapy and undergoing hemodialysis, who presented with fever, pleuritic chest pain, productive cough, and altered mental status. Chest computed tomography demonstrated multiple bilateral cavitating pulmonary nodules and pleural-based wedge-shaped opacities, consistent with septic pulmonary embolism. Blood cultures grew methicillin-susceptible Staphylococcus aureus. During hospitalization, she developed acute neurological deterioration with left-sided weakness. Brain magnetic resonance imaging revealed a large right frontal intraparenchymal hemorrhage, while magnetic resonance venography demonstrated thrombosis of the right transverse sinus and inferior sagittal sinus, confirming CVST complicated by hemorrhagic venous infarction. The patient was treated with targeted intravenous antibiotics and supportive neurocritical care. Anticoagulation was withheld due to active intracerebral bleeding. She showed gradual clinical improvement and was discharged in stable condition.
DISCUSSION: This case highlights the complex interaction between infection, autoimmune-mediated vascular injury, and hypercoagulability in SLE, resulting in simultaneous pulmonary and cerebral thrombo-infectious complications.
CONCLUSION: The coexistence of SPE, CVST, and ICH in SLE represents a rare but life-threatening scenario. Early recognition, prompt multimodal imaging, and coordinated multidisciplinary management are crucial for improving outcomes in high-risk patients.