Nickan Research Institute Journal of Renal Endocrinology 2423-6438 10 1 2024 01 01 A case with complication of overload versus diffuse alveolar hemorrhage in the setting of systemic lupus erythematosus: a case report and literature review e25158 e25158 10.34172/jre.2024.25158 EN Reza Asgari https://orcid.org/0000-0002-8502-1171 Mohammad Amin Bazzazan https://orcid.org/0000-0003-1026-5726 Sepide Hajian https://orcid.org/0000-0001-5404-2765 Journal Article 10.34172/jre.2024.25158 2024 05 22 2024 10 13 Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by its diverse clinical manifestations, affecting multiple organ systems. Overload and diffuse alveolar hemorrhage (DAH) are part of the many complications of SLE patients. Here, we present a known case of lupus that presented with symptoms resembling acute respiratory distress syndrome (ARDS). The patient exhibited markedly elevated pressures of 215 over 157 and demonstrated a high opacity on the initial hospital admission chest radiographs, which, upon further investigations, led to a differential diagnosis between pulmonary edema due to fluid overload and DAH. Relevant treatments were administered accordingly. Notably, in this case, despite the strong indication of DAH due to the remarkably low hemoglobin levels, the patient’s significant improvement resulted solely from treatments targeting fluid overload. Subsequently, a notable reduction in the patient’s chest radiographic opacity was observed.