Ms. Anjali Mohanty, an 11-year-old child was suffering from a critical case of Systemic lupus erythematosus (SLE), an autoimmune disease with multisystemic involvement Pediatric systemic lupus erythematosus (PSLE) is a rare condition representing approximately 10% of SLE cases. The child was on irregular treatment for the last 1 year and presented to AMRI hospital ED with status epilepticus. She had generalized edema, hypertension, and abnormal breathing pattern with low GCS. The child was intubated and shifted to PICU. Antibiotic, an antiepileptic drug, antihypertensive with strict input/output and vitals monitoring. 2d ECHO revealed global left ventricular hypokinesia with mild LV dysfunction with mild TR/PAH with LVH for which injection MILRINONE and FUROSEMIDE started. Given severe hypoalbuminemia, albumin infusion was given. In methylprednisolone pulse therapy started suspecting active flare-up. Seizure controlled, GCS improved and maintained saturation with minimal settings in ventilation. Nephrology consultation was taken and plasmapheresis 5 cycles with IVIG at the end of each cycle was given. Rituximab was started and continued monthly. The child was extubated and able to initially maintain saturation with oxygen support and then room air. MRI brain was done suggestive of diffuse cerebral atrophy with multiple hemorrhages in the cerebrum and cerebellum with vasculitis possibly PRES. The child was hemodynamically stable with proper treatment and processes, and oral feeds were started and discharged.