A 15-YEAR-OLD black girl with systemic lupus erythematosus (SLE) diagnosed at age 7 years presented with fever and respiratory distress. Her symptoms began about 2 weeks prior to admission when she was diagnosed as having bronchitis by her pediatrician and was given amoxicillin. Her usual medicines included 40 mg of prednisone alternating with 10 mg daily, 40 mg of furosemide every day, and 50 mg of triamterene every day. She showed transient improvement with antibiotic treatment, but then her symptoms progressed until she started having difficulty walking between classes, when she was admitted to the hospital.
Atadmission, the patient's temperature was 39.3°C. She was dyspneic at rest with a respiratory rate of 28 breaths per minute and a room air oxygen saturation of 86%. Her chest examination demonstrated crackles in the right middle lobe area with decreased air movement in the bases bilaterally. Laboratory evaluation revealed the following levels: anti-DNA,