Systemic lupus erythematosus (SLE) usually affects young females and its presentation with haemorrhage is unusual. Intracerebral bleed (ICB) has been described in a few case reports, but massive haematuria has not been reported in the literature so far. Here, we present a case of a 56 year-old-lady who presented with expanding lobar bleed and massive haematuria as the first presentation of SLE secondary to vasculitis. Lupus vasculitis usually presents with thrombosis-related complications and although bleeding in this context is rare, it can lead to catastrophic consequences. Hence, vasculitis-related bleeding should be taken under consideration in a challenging situation like ours.
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