I wonder, if true, that this could be "steroid Psychosis". One of the treatments for lupus is prednisone and it will cause Psychosis in high doses or long term use.
I wondered exactly the same thing. There are people on other forums speculating that she looks like she could be pregnant, because she looks so different from the family portrait we all saw.
My thoughts were that her face looked puffy, like moonface from prednisone.