Successful rituximab therapy in refractory systemic lupus erythematosus with multi-organ involvement: a case report

Background. Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease with potential multisystem involvement and unpredictable flares. Severe disease can lead to diverse, overlapping complications that challenge diagnosis and management. Case presentation. A 26-year-old female with refractory systemic lupus erythematosus developed multiple severe complications, including macrophage activation syndrome (MAS), multifocal avascular necrosis (AVN), interstitial lung disease, and late-onset severe pulmonary arterial hypertension. Despite receiving standard disease-modifying and immunosuppressive therapies, her SLE remained highly active and unresponsive to conventional treatment strategies. Initiation of rituximab led to marked improvement in disease control, underscoring its role as an effective therapeutic option in severe, treatment-resistant SLE. Conclusion. This patient’s clinical course illustrates the complexity of refractory SLE with combined vascular, pulmonary, and skeletal sequelae. Early recognition of organ damage, individualized immunosuppressive strategies, timely biologic intervention, and coordinated multidisciplinary care are pivotal for improving outcomes in patients with aggressive SLE phenotypes.