A 25-year-old woman had systemic lupus erythematosus manifested primarily by severe cutaneous vasculitis that was unresponsive to oral prednisone and azathioprine. She was treated with thoracic duct drainage (TDD). Her course was followed by serial photographs, skin biopsies, and serum immunoglobulin, antinuclear antibody, and complement levels. After 1 week of drainage there was obvious clinical improvement. During the remainder of her drainage, the vasculitis continued to improve. It was possible to taper oral corticosteroids and to discontinue azathioprine during TDD without any clinical or laboratory evidence of exacerbation. The patient had no recurrence of vasculitis 22 weeks after the termination of TDD.
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