CASE PRESENTATION: A 23-year-old African American female presented with rash, fatigue, arthralgias and dry cough. She was febrile, hypotensive, tachycardic and tachypnic. Physical exam was significant for oral ulcers, coarse rhonchi in bilateral lung fields, scaly hyperpigmented plaques on her face and erythematous macules on the lower extremities. She decompensated rapidly requiring intubation and was admitted for further evaluation. Initial laboratory analysis were significant for pancytopenia, mild transaminitis, a protein gap and proteinuria. Chest imaging showed dense consolidation in the lower lobes (Image 1). The patient underwent a bronchoscopy, which noted clear airways without pus or blood; sequential alveolar aliquots were not consistent with alveolar hemorrhage. An extensive infectious workup was negative; however, autoimmune workup was positive (Table 1). A clinical diagnosis of SLE was made. The patient failed to improve on antibiotics; low dose steroids were added with no change. Acute lupus pneumonitis was considered given the negative infectious workup and the persistent lower lobe opacities. She was started on pulse dose steroids with rapid radiographic resolution and clinical improvement, facilitating extubation.