Diffuse alveolar haemorrhage as an initial presenting manifestation of juvenile systemic lupus erythematosus

A fifteen year old female child presented with three weeks history of fever and joint pains. On evaluation, infections were ruled out and a diagnosis of systemic lupus erythematosus with involvement of domains of musculoskeletal, constitutional, haematological and probable lupus nephritis was made. During period of evaluation, she developed diffuse alveolar haemorrhage(DAH) and was managed with methylprednisolone pulse therapy, intravenous immunoglobulin and plasma exchange along with cyclophosphamide. The case report discusses the challenges faced in suspecting, diagnosing and treating DAH, with a propitious outcome.