Background <p>Systemic lupus Erythematous (SLE) with its multisystem manifestations can sometimes throw the treating team into scientific oblivion. Bone marrow suppression increases the susceptibility to infection and life-threatening bleeding manifestations and hence timely diagnosis and treatment can be lifesaving in these patients.</p> Case presentation <p>Here we report such a young case of SLE who presented with anasarca, polyarthritis and other musculoskeletal manifestations. She was initially managed with steroids along with the evaluation of subnephrotic proteinuria with renal biopsy. Thereafter the disease followed a treacherous course with new onset pancytopenia and worsening renal parameters. It heralded the development of petechiae over the body and gum bleeding. Pulse steroids with broad spectrum antimicrobials were started considering sepsis or autoimmune pancytopenia. Her blood counts worsened further. Bone marrow examination revealed autoimmune aplastic anemia while renal biopsy showed class IV nephritis. The patient was treated with intravenous immunoglobulins and cyclophosphamide. Subsequently, she responded to the therapy and her blood counts and renal function gradually improved. On follow up, anasarca has resolved completely with normal blood and renal parameters.</p> Conclusion <p>Timely aggressive therapy can save a life from such devastating conditions like autoimmune aplastic anemia.</p> Clinical trial number <p>Not applicable.</p>