A 17-year-old unmarried woman from rural background with lower socioeconomic status reported to the general medicine department. She had a history of 2 months of fever and joint pain and a history of 5 days of cough. She was diagnosed to have cutaneous lupus erythematosus for a year, and she was under 20 mg/ day of prednisolone (tablet) in divided doses. The patient was admitted and evaluated. General physical examination revealed pallor, icterus, hyperpigmentation all over her body, including face, erythematosus skin lesions, diffuse hair loss, depigmented patches over the scalp, and erosions in the buccal mucosa. Chest radiograph was suggestive of miliary tuberculosis, and an electromyographic study was suggestive of mixed neurogenic and myogenic pathology. Most of the baseline biochemical and hematological investigations (except Hb% 8 g% and total bilirubin 4 mg/dl) were within normal limits. Immunological investigations showed positive anti-UI/Sm ribonucleoprotein antibody (RNPAb), anti-Sm Ab, anti-ds deoxyribonucleic acid (DNA) Ab, anti-histone Ab, anti-nucleosomal Ab, and anti-ribosomal Ab. The human immunodeficiency virus (HIV) test was nonreactive. After the review by the immunologist, the patient was diagnosed to have SLE with myositis with military tuberculosis. She was treated with 200 mg of ciprofloxacin bid (injection), 100 mg of amikacin iv tid (injection), 100 mg of hydrocortisone iv bid (injection), 1 g of ceftriaxone iv od (injection), and 400 mg/day of ethambutol (tablet). The patient was free from psychiatric complaints for initial 1.5 months. For 15 days, the patient presented with muttering, smiles to self, occasional crying spells, irrelevant speech, anger outbursts, and decreased sleep. There was no alteration in medication, changes in dosages, or onset of any fresh physical complaints in these 15 days. There was no history of either SLE or major psychiatric illness in family. There was no history of psychosis, depression, or mania, but she was premorbidly well adjusted. Mental status examination revealed poorly kempt, irrelevant speech, second person auditory hallucination, reduced range of mood, and absence of insight. The patient was diagnosed as organic delusional [schizophrenia-like] disorder (ICD-F06.2). The patient was started on 10 mg/day of olanzepine (tablet) and increased to 20 mg/day. The patient showed 50% improvement in the first week, and she was discharged later.