A Woman with Vaginal Bleeding and Anemia

She also reported months of progressive proximal muscle weakness, alopecia, and vaginal bleeding, ultimately culminating in a life-threatening hemorrhage. Evaluation showed diffuse lymphadenopathy, splenomegaly, hematuria with proteinuria, and a markedly elevated erythrocyte sedimentation rate (ESR) with mildly elevated C-reactive protein (CRP). Autoantibodies associated with systemic lupus erythematosus (SLE) were positive, and a kidney biopsy stained brightly for multiple immunoglobulins. She was given a diagnosis of SLE-myositis overlap syndrome.