Management There is no specific treatment for SLE Rather, therapy consists of immunosuppression, the types and intensities of which are dictated by the particular organ systems affected Patients with mild disease (fever and/or arthritis) without nephritis generally receive one of the nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., naproxen sodium 15 to 20 mg/kg/day, maximum 1,000 mg) Severe systemic features, on the other hand, usually require treatment with oral or IV corticosteroids, with doses divided three or four times daily in the most florid cases Patients with life-threatening disease, particularly those with severe renal or CNS involvement, may require so-called “pulsed” doses of corticosteroids (IV methylprednisolone, 30 mg/kg/day, maximum g), plasmapheresis, or an immunosuppressive agent (especially mycophenolate mofetil, azathioprine, rituximab, cyclophosphamide, or the recently approved belimumab) ( Table 101.2 ) Symptomatic management may be necessary for the treatment of seizures, psychosis, or acute renal failure With rare exception, patients should also receive hydroxychloroquine, which prolongs disease-free remissions once signs and symptoms of active lupus are controlled Close follow-up is mandatory to detect clinical and serologic evidence of disease flares, and to monitor drug toxicity Management of Complications and Emergencies Infections in SLE Management of emergencies in patients with SLE first and foremost involves distinguishing primary disease manifestations from secondary complications ( Table 101.3 ) Infection is the major cause of mortality in childhood SLE Gramnegative bacilli (especially Salmonella ), Listeria, Candida, Aspergillus, Cryptococcus, Toxoplasma, Pneumocystis, and varicella-zoster virus are some of the organisms associated with severe infections in SLE Patients with SLE who are receiving corticosteroids or cytotoxic drugs are at even higher risk for developing viral, mycotic, and other opportunistic infections The majority of these infections are diagnosed at autopsy, so clinicians must maintain a high level of suspicion for infection in all children with SLE Not all patients with lupus and suspected infection require hospitalization Patients with minor infections who are not acutely ill or neutropenic may be treated with close follow-up and appropriate antibiotics given orally The dose of corticosteroids should also be increased to provide stress coverage in any acutely ill child who has received more than 20 mg of prednisone daily for more than weeks within the previous 12 months Acutely ill children, those with an absolute neutrophil count of