Abstract: Objective: To analyze the hematological changes of systemic lupus erythematosus(SLE) and the clinical characteristics of immune-related hypoglycemia,and to provide the basis for the diagnosis and treatment of SLE complicated with autoimmune hypoglycemia(AIH). Methods: The clinical data a patient with SLE complicated with AIH with pancytopenia as the first manifestation were collected and the relevant literatures were reviewed. Results: A 70-year-old man was admitted to hospital because of dizziness and fatigue,and suffered from more than 3 months,aggravated for 2 weeks. The physical examination results showed pale conjunctiva,moist rales over the both lower lung and there were no other obvious positive signs. The blood test showed pancytopenia and the fasting blood glucose 2.34 mmol·L^-1.The pathomorphology of tissue was observed by bone marrow puncture;rheumatism examinations,glucose metabolism indexes,insulin autoantibodies(IAA) and other assistant examinations were performed,and the patient received the related treatment.The patient had a history of photosensitivity. Admission examinations indicated multiple serous effusions,urinary protein >0.5g·24 h^-1,pancytopenia, abnormal antinuclear antibody(ANA) titer, pancreatic CT(-), and the patient was diagnosed as SLE complicated AIH finally.After treatment of prednisone,the symptoms of the patient were improved; the the whole blood count and fasting blood glucose responded well to the therapy of prednisone. After discharge from the hospital,the patient was treated with prednisone continuously and was required to regularly monitor the blood test and the blood glucose level. The patient's whole blood count was gradually increased and no hypoglycemia occurred. Conclusion: SLE with hematological changes as the first manifestation is easily misdiagnosed. And autoantibody-mediated glucose homeostasis should be considered when SLE is complicated with hypoglycemia.

Key words: systemic lupus erythematosus, autoimmune hypoglycemia, type B insulin resistance syndrome, insulin receptor autoantibodies, pancytopenia