Contemporaneous Onset of Systemic Lupus Erythematosus and Severe Eating Disorder: Neither the Chicken Nor the Egg

A 14-year-old girl presented with systemic lupus erythematosus (SLE) and severe malnutrition due to an avoidant and restrictive food intake disorder (ARFID). Despite the temporal proximity of SLE and the eating disorder, the study suggests that the shared risk factors related to adolescence, such as hormonal changes and social stressors, may act as a mediating "third factor" linking the two conditions, rather than the eating disorder being a neuropsychiatric manifestation of SLE. The patient showed improvement with enteral feeding, prednisone, hydroxychloroquine, and psychological support. This case highlights the complexity of diagnosing and treating concurrent SLE and eating disorders in adolescents.