Systemic lupus erythematosus (SLE), also known simply as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body.

A65-year-old Iranian woman,with history of lower abdominal pain and occasional dysuria. She also related a 1-week history of fever, loss of appetite, generalized weakness, a nonspecific cough, and a single episode of vomiting on the day of her visit. Her medical history was notable for illnesses of atopic dermatitis, migraines, and occasional nonspecific chest pains. Pancreatic enzymes determinations disclosed an amylase level of 134 U/L (normal 30–110 U/L) and a lipase level of 712 U/L (normal 23–300 U/L). Urinalysis showed cloudy urine with protein 300 mg/dL, a white cell count of 12–20 per high-power field (HPF), granular casts 1–2/HPF, bacteria loaded, and many epithelial cells. Nitrite and leukocyte esterase were negative.A computed tomographic (CT) scan of the abdomen with contrast showed no evidence of gallbladder stones with marked swelling of the pancreas. A sonogram on day 3 of admission showed a possible left pleural effusion, swelling of the pancreas . Connective tissue workup showed a antinuclear antibody (ANA) titer 1:1280, anti-double-stranded DNA antibody positive, anti-DNA titer 1:640, anti-Smith antibody positive, anti-ribonucleoprotein positive, anti-SSA and anti-SSB negative, complements C4 < 10 mg/dL (normal 16–47 mg/dL), C3 16 mg/dL (normal 83–201 mg/dL), anticardiolipin antibodies were elevated, immunoglobulin G (IgG) was 23 g/L (normal 0–14 g/L) and IgM 24 mg/L (normal 0–9 mg/L). Lupus anticoagulant was negative. Repeated CT scans were performed on days 13, 25, and 33 to rule out microabscesses as a source of her fever, but no pancreatic pathologic lesions were seen.

SLE can involve any organ system. It is important that the family physician, who treats patients as a whole, suspect SLE when a straight forward diagnosis is associated with inexplicable multiple concomitant abnormalities.