Three young women with systemic lupus erythematosus who were given ibuprofen for arthritis voluntarily discontinued taking the drug. On reinstitution of therapy, profound hypotension, fever, and headaches developed within hours, without other identifiable cause. A possible relationship to salicylate intolerance was considered. Because of these apparent side effects, we stress caution in the use of ibuprofen in systemic lupus erythematosus, particularly if there is any history of salicylate intolerance.