Objective: This study was conducted to assess the various modes of presentation of systemic lupus erythematosus SLE in our setup at a tertiary care hospital in periphery of Sind. Methadology: This retrospective, descriptive and analytical study was planned to study the various modes of presentation of SLE patients in our set up admitted in LUMHS hospital during the period of March 2006 to Jan 2011. Thirty three adult patients were included in this study. Special proforma were prepared to record the information from case sheets of patients including basic information, symptomatology and laboratory investigations. The criteria used in this study were from the American College of Rheumatology (ACR). Inclusion criteria in this study were, patients presenting with four of the eleven criteria. Statistics:For statistical analysis of the results, statistical package SPSS version 10 was used. Data was presented in Mean ±SD and frequency (percentage in respective sex). Results: In this study patient's age ranged from 20-65 years. The mean age was 35±7.5 years and median age was 30 years. Out of 33 patients 31 (94%) were females. Two (6%) were male patients. F/M ratio was 15.5:1.23 (69.6%) patients presented with skin lesions particularly with malar rash and discoid lesions. 32 (97%) patients presented with arthralgia and arthritis. 17 (51.5%) patients had history of photosensitivity and 20 (60.6%) patients were found to have oral ulcers. 31 (94%) patients presented with high grade fever. 18 (54.5%) patients developed neuropsychiatric complications. 11 (33%) patients presented with renal manifestations. 18 (54.5%) patients had various infections. Anemia was found in 27 (81.8%) patients. 7 (21%) patients presented with mild pleural effusion and pleural rub. 3 (11%) patients presented with vasculitis. Splenomegaly was found in 25 (75.7%) patients. All 33 (100%) patients were ANA positive, and 22 (66.6%) patients had anti ds DNA positive, none was found to have false VDRL test positive. Demographic data and clinical features are shown in Table 1 and 2. Conclusion: In this study it is concluded that by carefully observing the various modes of presentation of SLE in our setup in a tertiary care hospital, the diagnosis will be made early and complications may be prevented.