Abstract
Sir,Fever is one of the most challenging problems insystemic lupus erythematosus (SLE) and the fol-lowing example may be paradigmatical. A 53-year-old woman diagnosed with SLE (2001: fever,arthritis, subacute cutaneous lupus, anti-dsDNA,ANA and anti-Ro positivity) with ongoing therapywith hydroxychloroquine (200mg/day) and lowdose prednisone (2.5mg/day) in October 2009 pre-sented with fever (up to 38 C) and arthromyalgiasnot responsive to prednisone increase up to25mg/day and broad-spectrum antibiotics treat-ment. When she was admitted to our division(December 2009), we first empirically started withlevoxacin (500mg/day, intravenous (i.v.)).Considering fever persistence, signs of disease activ-ity (anti-dsDNA and direct Coombs’ test positivity,C3 and C4 reduction, leukopenia) and the negativ-ity of procalcitonin
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