DOI: https://doi.org/10.36347/sjmcr.2026.v14i04.058

Pages: 830-832

Interstitial lung disease (ILD) is an uncommon manifestation of Systemic lupus erythematosus (SLE), occurring in only 1–4% of patients, and may rarely represent the initial presentation, particularly in elderly individuals. We report a 72-year-old man with progressive exertional dyspnea and chronic dry cough without systemic or rheumatologic features. High-resolution computed tomography demonstrated fibrotic interstitial pneumonia of idiopathic fibrotic pattern, characterized by reticulations, traction bronchiectasis, subpleural micronodules, and early architectural distortion. Serologic testing revealed positive antinuclear antibodies, high-titer anti–double-stranded DNA antibodies, and weak anti-Ro52 positivity, while minor salivary gland biopsy showed focal lymphocytic sialadenitis insufficient for Sjögren syndrome. Multidisciplinary evaluation established the diagnosis of late-onset SLE presenting predominantly with fibrotic ILD. This case highlights the diagnostic challenge of lung-dominant lupus, which may mimic idiopathic fibrotic pneumonias, and underscores the importance of radiologic-immunologic correlation for early diagnosis and appropriate management.