The patient, a 21-year-old woman, was admitted to the intensive care unit with a 4-day history of fever, arthritis of the hands and feet, oli- guria with anasarca, diarrhea, and widespread skin rash. Systemic lupus erythematosus had been diagnosed 5 years previously. She was positive for lupus anticoagulant and anticardiolipin antibody but had no history of thrombotic or obstetric manifestations. Laboratory tests for infection and immunologic or biochemical abnormalities were performed and, based on multiple abnormal findings, treatment with broad-spectrum antibiotics was instituted.