A 50-year-old woman with a medical history of hypertension, ischemic heart disease (IHD), and systemic lupus erythematosus (SLE) was not taking medication for her SLE treatment. She tested positive for antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibody. Three months ago, she went to a nearby hospital with symptoms of difficulty in breathing and shortness of breath, and she was treated for pulmonary tuberculosis with anti-tuberculosis (ATT) medication without any definitive evidence of tuberculosis. However, her condition did not improve and even worsened during her three-month medication period. She was then admitted to our healthcare center with complaints of mouth ulcers, a malar rash on her cheeks, joint pain, difficulty breathing, and signs of rapid heart rate and breathing. During the examination, it was found that her joints were swollen and tender, there were crackles in both lungs, and reduced air entry. At the time of admission, her vital signs were BP 90/60 mmHg, PR 120BPM, RR 30BPM, Temp 37.7C, and SpO2 86%. Our team of doctors, including a general physician, rheumatologist, and pulmonologist, took her case for further management. Relevant labs and imaging were ordered, as shown in Table 1, and chest X-ray showed fluid accumulation around the lungs, as shown in Fig. 1. The fluid was sent for analysis, and it was discovered that the medication she was taking for tuberculosis was causing the problem. The medication was stopped, and the patient was treated as a case of primary SLE with superimposed drug-induced SLE. She was given high-flow oxygen, intravenous methylprednisolone 1g OD for 3 days, tablet hydroxychloroquine (HCQ) 200mg BD, Mometasone lotion for skin rash, Nilstat drops for oral ulcer, and tablet celecoxib 600mg OD. After 5 days of treatment, the patient improved and was discharged with stable vital signs. She was prescribed tablet prednisone 5mg BD with tapering protocol, tablet HCQ 200mg BD, and topical Mometasone lotion for 10 days. She was asked to follow up with a rheumatologist.