Hemolytic uremic syndrome (HUS) as an initial presentation of systemic lupus erythematosus (SLE) is a rare finding. We report a 25-year-old female patient who presented to our hospital with complaint of fever, joint pain, anasarca, hematuria and nose bleed. Her diagnostic workup revealed renal failure, microangiopathic hemolytic anemia and thrombocytopenia due to SLE with HUS. The patient initially responded well to treatment with steroids, plasmapheresis with cryosupernatant and cyclophosphamide but finally succumbed to enterococcus septicemia.
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