Search for a command to run...
Objectives The concept of difficult-to-treat (D2T) Systemic Lupus Erythematosus (SLE) is currently being investigated.This report presents a clinical case of a patient with SLE and Sjgren's syndrome who was difficult to treat.The patient was treated with biologics, immunosuppressants (IS), and glucocorticosteroids (GC).Methods In August 2025, a 30-year-old man was readmitted to hospital with red rashes on his nose and cheekbones.SLE developed in December 2023, at the age of 28, after pneumonia, initially manifesting as arthralgia, later accompanied by thrombocytopenia (platelet count 52 g/l) and leukopenia (leukocyte count 1.38 g/l).Hematologists have ruled out myeloproliferative diseases. ResultsThe patient was diagnosed with SLE and Sjgren's syndrome in October 2024, during his first admission based on the presence of arthritis, hematological disorders (thrombocytopenia, leukopenia, and Coombs anemia), serositis (pericarditis), general symptoms (subfebrile fever and weight loss), and immunological disorders (highly sensitive anti-dsDNA, hypocomplementemia, antiphospholipid antibodies, positive ANA, and anti-Ro+ and anti-La+) (SLICC criteria 2012).Disease activity was high (SLEDAI-2K: 10; SLEDAS: 45.11).A severe outbreak occurred, leading to subclinical autoimmune myocarditis, detected by echocardiography and confirmed by elevated pro-BNP levels.Initial therapy included GC 40 mg/ day and HCQ 200 mg/day.After leukocyte normalization, the patient received rituximab 3 g (October 2024, last infusion in May 2025) and mycophenolate mofetil (MMF) 2 g/day starting December 2024, after which arthritis resolved and laboratory values normalized.However, in March 2025, MMF was discontinued due to a herpes zoster episode.By May 2025, SLE activity was low (platelet count 85 g/L) and hypocomplementemia, and GC dose was 15 mg/day.In June 2025, following sun exposure, acute cutaneous lupus developed for the first time, with a resurgence of leukopenia and thrombocytopenia.Treatment included GC 12.5 mg/day and HCQ 400 mg/day.In August 2025, due to inadequate efficacy of rituximab (3 g), intolerance to MMF, and limitations on IS (due to leukopenia), initiation of therapy with anifrolumab 300 mg IV infusion was decided.The patient's condition has now stabilized, and they continue antiviral therapy.Conclusions This case illustrates a patient with a short disease duration who, despite biologics and immunosuppressants, GC, experienced a flare as acute cutaneous lupus.