Barw Barw Medical Journal 2960-1959 2025 09 29 Three in One: Systemic Lupus Erythematosus, HELLP Syndrome, and Antiphospholipid Syndrome: A Case Report with Literature Review 82 85 10.58742/bmj.vi.208 eng Sivan H. Salih Gastroenterology Department, Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. sivan.salih@gmail.com Dana T. Gharib Gastroenterology Department, Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. dana.gharib@gmail.com Nahida H. Ahmad Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. nahida.ahmed@gmail.com Hoshmand R. Asaad Gastroenterology Department, Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. hoshmand.asaad@gmail.com Ronak S. Ahmed Shahid Nabaz Dermatology Teaching Center for Treatment of Skin Diseases, Sulaymaniyah Directorate of Health, Sulaymaniyah, Iraq. ronakahmed76@gmail.com Huda M. Muhammad College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. huda.muhammed@univsul.edu.iq Jihad I. Hama Research Center, University of Halabja, Ababaile Village, Halabja, Iraq. jihad.hama@gmail.com Kayhan A. Najar Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Azadi Mall, Sulaymaniyah, Iraq. kayhan.najar@gmail.com Karokh F. Hamahussein Gastroenterology Department, Gastroenterology and Hepatology Teaching Hospital, Zanko Street, Sulaymaniyah, Iraq. karokh.hussein@gmail.com Hawkar A. Nasralla Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. Hawkar.arf96@gmail.com 2025 07 29 Introduction Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease commonly affecting women of reproductive age. Its overlap with HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) and antiphospholipid syndrome (APS) during pregnancy is rare and presents diagnostic and therapeutic challenges due to shared clinical and laboratory features. This report describes a case of pre-existing SLE complicated by the concurrent occurrence of SLE flare, HELLP syndrome, and APS during pregnancy. Case presentation A 26-year-old female with known SLE presented with right upper quadrant abdominal pain and hypertension two days following a mid-trimester abortion at 22 weeks of gestation. Laboratory evaluation revealed thrombocytopenia, elevated liver enzymes, and hemolysis, consistent with HELLP syndrome. The presence of lupus anticoagulant and anticardiolipin antibodies, in conjunction with her obstetric history, supported the diagnosis of APS. The patient was treated with high-dose corticosteroids and anticoagulation, resulting in significant clinical improvement. Literature review A review of literature highlights the consistent presentation of nonspecific symptoms such as abdominal pain, nausea, and hypertension in patients with overlapping SLE, HELLP syndrome, and APS. Laboratory findings often reveal thrombocytopenia, elevated liver enzymes, and hemolysis, reflective of underlying microangiopathic processes. Therapeutic strategies typically involve corticosteroids and anticoagulation, with plasmapheresis reserved for severe cases. Conclusion The coexistence of SLE flare, HELLP syndrome, and APS during pregnancy is a rare and complex condition that requires careful evaluation. Early recognition and appropriate management are crucial for achieving favorable outcomes.