Systemic Lupus Erythematosus Presenting Primarily With End-Stage Renal Disease in Men: A Case Report.

This case report describes a diagnostically challenging presentation of systemic lupus erythematosus (SLE) in a 37-year-old male patient with a five-year history of isolated chronic kidney disease (CKD) requiring hemodialysis, who acutely developed progressive multi-organ failure. Initial evaluation revealed severe pancytopenia, hypoalbuminemia, elevated cardiac biomarkers, and multi-cavity effusions. Autoimmune serology confirmed the diagnosis of SLE with characteristic autoantibodies. Critical complications included refractory septic shock, extensive coronary artery disease, splenic infarction, cerebral hemorrhage, and terminal multi-organ failure. Despite multidisciplinary intervention, rapid clinical deterioration resulted in a fatal outcome. This case highlights that isolated CKD can obscure SLE onset in men, emphasizing the need for early serological screening in unexplained multisystem deterioration, even in the absence of classic lupus features, to prevent diagnostic delays and fatal complications. To our knowledge, this is the first report of SLE in a male patient presenting as isolated CKD for five years before fatal multi-organ failure, highlighting gender-specific diagnostic challenges.