No abstract available. Article truncated at 150 words. History of Present Illness: A 39-year-old Hispanic woman was admitted complaining of shortness of breath and bilateral lower extremity edema. She was felt to be in acute hypoxic respiratory failure. Past Medical History: Systemic lupus erythematosus; Congestive heart failure with an ejection fraction of 40%; End-stage renal disease on dialysis secondary to lupus nephritis. Medications: Rituximab 550 mg once a week; Prednisone 40 mg daily; Plaquenil 200 mg twice a day. Physical Examination: The patient was tachypneic in obvious respiratory distress. She was afebrile. Crackles at the bases. Heart was tachycardic. There was 3+ bilateral pitting pretibial edema. Laboratory: CBC: Hemoglobin 7.8 g/dL, WBC 11 X 109 cells per liter, differential: neutrophils 98%, eosinophils 0%, lymphocytes 1%. Electrolytes: Potassium 5.8 mEq/L, sodium 143 mEq/L, creatinine 3.3 g/dL, BUN 98 mg/dL. Brain naturetic peptide: 4055 pg/ml. Imaging: Admission chest x-ray showed cardiomegaly and bilateral interstitial prominence suggestive of congestive heart failure ...