Adolescent with Abdominal Pain and Altered Mental Status: Are You Confused?

The presenting manifestations of systemic lupus erythematosus (SLE) are diverse and can present insidiously over years with nonspecific complaints or acutely with life-threatening symptoms. We report a case of a previously healthy 18-year-old female who presented to the pediatric emergency department with altered mental status, multi-system organ failure, and fulminant sepsis from pneumococcal meningitis. Further work-up of this patient confirmed a new diagnosis of SLE. This case highlights the potential degree of immune dysfunction in patients with SLE by opportunistic agents and common pathogens. A high index of suspicion for SLE in childhood is important as delays in diagnosis can lead to life-threatening complications and long-term sequelae.