A 22-year-old African American woman presented with worsening left hip pain precluding ambulation. Seven years earlier, systemic lupus erythematosus (SLE) was diagnosed in the setting of fatigue, malar rash, polyarthritis, and photosensitivity, with antinuclear antibody, ds-DNA, Smith, ribonucleoprotein, Ro, and La seropositivity. Subsequent manifestations included aseptic meningitis, cutaneous vasculitis, and diffuse proliferative glomerulonephritis. Therapy included cyclophosphamide, prednisone, mycophenolate mofetil, and hydroxychloroquine. Average prednisone dose over 4 years was 20 mg daily.
Two years before presentation, …