Abstract
We report on a 29-year-old mother who presented with acute ascending paralysis who required mechanical ventilation due to severe hypokalaemia. She was found to have normal anion gap metabolic acidosis due to distal renal tubular acidosis. She had ACR and SLICC criteria compatible with diagnosis of latent SLE. SLE is an evolving disease over a lifetime of a patient until it fulfills criteria for clear diagnosis, which makes the management challenging. Early disease may not uncommonly show nonspecific presentation, a single classification criterion, or an unusual organ involvement contributing to frequent, often substantial diagnostic delays. This case is noteworthy for its atypical presentation of SLE. This case demonstrates how unwell and rare a patient with SLE can present. Comprehensive history and examination focusing on systemic and joint symptoms and mucocutaneous involvement, and basic tests (focusing on leukopenia, thrombocytopenia, and proteinuria; followed by antinuclear antibodies and complement levels) will correctly diagnose most patients on presentation or within the following months and enable timely treatment. She was successfully treated with potassium replacement and potassium citrate and sodium bicarbonate supplementation. We also acknowledge the need to further understand and raise awareness of this uncommon presentations in SLE.