A 32-year old female with a history of SLE and rheumatic heart disease presented with shortness of breath, leg swelling, and oliguria. Examination revealed signs of heart and kidney failure. Tests confirmed lupus nephritis and positive autoimmune markers. She was treated with antibiotics, diuretics, and steroids, followed by plasma exchange and renal biopsy showing class II lupus nephritis. She later developed fever and a new heart murmur, and was diagnosed with infective endocarditis treated with antibiotics.