Systemic lupus erythematosus predominantly affects young women during childbearing age. It is rare after the age of 90, and there is no report of very late onset in persons over 90 in China. Here, we reported a case of a female patient, the onset age of whom was 90, analyzing her clinical features and treatments. And when conducting a pooled analysis of late-onset cases in the literature, we found that the organ damages and severity of lupus disease of old-onset SLE were not benign, and considering their ages, comorbidities and high rate of mortalities, appropriate interventions and close follow-up for this age group are needed.