Systemic Lupus Erythematous (SLE) is an autoimmune disease that can affect multiple organs and can have a wide variety of symptomatic presentations. One rare presenting symptom is oculomotor nerve dysfunction, the following case report is of a 41-year-old female with a past medical history of hypertension and asthma, who was admitted for ocular dysfunction. On physical examination, the patient had an ocular palsy, but the rest of the neurological exam was unremarkable. Imaging modalities such as computed tomography (CT) scan head without contrast, brain magnetic resonance imaging, and computed tomography angiography (CTA) of the head and neck revealed no acute pathology. After a neurological etiology was excluded an autoimmune diagnosis was pursued. Lab results were positive for Anti-Smith, ANA, and Anti-DsDNA. The patient also at this time was also diagnosed with an acute kidney injury and a kidney biopsy that was done later revealed focal lupus nephritis. After starting immunosuppressive therapy, her symptoms improved.

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