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Previous Volume 337:1777-1778 December 11, 1997 Number 24 Next

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To the Editor: A 24-year-old woman received the diagnosis of systemic lupus erythematosus at 11 years of age. Since then, she has had episodic flares characterized by fatigue, fever, malar rash, arthralgias, abdominal pain, and lupus nephritis. Dialysis and mechanical ventilation have been required intermittently, and she has been treated with plasmapheresis, corticosteroids, hydroxychloroquine, methotrexate, azathioprine, and cyclophosphamide, none of which allowed a tapering of prednisone to a dose of less than 20 mg a day. Since the age of 11 years, her hemoglobin level has ranged from 6.5 to 7.2 mg per deciliter (4.0 to 4.5 mmol per liter), . . . [Full Text of this Article]

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