Systemic Lupus Erythematosus Complicated by Nephritis and Macrophage Activation Syndrome, Not Responsive to High-Dose Immunosuppression

A 15-year-old girl from a VL-endemic area in Greece presented with symptoms indicative of systemic lupus erythematosus (SLE), including high-grade fever, arthralgias, hematuria, malar rash, alopecia, and organ involvement such as hepatosplenomegaly and pleural effusions. Laboratory findings showed Coombs-positive anemia, leukopenia, nephrotic-range proteinuria, and hypocomplementemia. Despite high-dose immunosuppression, her condition, complicated by nephritis and macrophage activation syndrome, did not respond to treatment.