Suppression of the haematopoietic system, especially of the myeloid lineage, is a severe complication of systemic lupus erythematosus (SLE).1 In a recent report Euler et al suggested rhG-CSF as an effective treatment of neutropenia during SLE, especially during infection resistant to antibiotic treatment.2 We present a case of a girl with SLE whose neutropenia did not respond to rhG-CSF and who subsequently succumbed to untreatable fungal sepsis.

A previously healthy 9.5 year old girl developed SLE presenting with six of 11 criteria of the American College of Rheumatology including butterfly rash, oral ulcers, arthritis, and serositis. Laboratory investigations demonstrated ANA+, anti-dsDNA+, hypocomplementaemia, but normal white blood cell count. Eight months after initial remission she had a relapse, presenting with neutropenia (650 neutrophils/μl, 800 lymphocytes/μl) and signs of nephritis. Bone marrow biopsy examination showed a general suppression of all …