This is a 35-year-old woman with systemic lupus erythematosus (SLE), lupus nephritis, and alcohol-related cirrhosis who presented to clinic with pleuritic chest pain. She was admitted to an outside hospital where labs showed hemoglobin of 9.0, low complements (C3: 56, C4: 3), and elevated anti-dsDNA antibodies(>300), consistent with an SLE flare. Rifampin was initially withheld but after interdisciplinary discussion, it was started alongside the SLE regimen without evidence of adverse effects. However, this approach must be carefully balanced, as both SLE flare-ups and TB reactivation represent competing clinical risks.
