Systemic lupus erythematosus flare up manifestation as cerebral and spinal subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is an uncommon complication of systemic lupus erythematosus (SLE). Here we report a 52-year-old woman with flare up of lupus activity, manifesting as spontaneous cerebral and spinal SAH due to central nervous system vasculitis. The patient received external ventricular drainage for hydrocephalus and pulse steroid and intravenous cyclophosphamide therapies. Her neurological deficits gradually improved with only minimal gait unsteadiness at discharge. Although very rare, cerebral and spinal SAH related to vasculitis could be one of the presentations of SLE flare up.