Tocilizumab (Actemra; Genentech, Inc) is the first biologic therapy targeting 
the cytokine interleukin 6 (IL-6). It is a humanized monoclonal immunoglobulin 
G1 antibody against the α-chain of the IL-6 receptor that prevents the binding 
of IL-6 to membrane-bound and -soluble IL-6 receptor. It was approved by the US 
Food and Drug Administration in January 2010 for rheumatoid arthritis refractory 
to other approved therapies and in April 2011 for systemic juvenile idiopathic 
arthritis. It has been used as an off-label treatment in many autoimmune 
diseases, where IL-6 plays a major role in pathogenesis. We report a case of 
refractory systemic lupus erythematosus in a 22-year-old woman with recurrent 
high-grade fever, polyarthritis, diffuse rash with urticarial vasculitis, and 
tumid lupus who did not respond to topical corticosteroids, photoprotection, 
antimalarials, methotrexate, anakinra, mycophenolate mofetil, etanercept, and 
intravenous immunoglobulin therapy. Symptoms recurred after corticosteroid 
tapers below 10 mg. She was noted to have an elevated IL-6 level, and 
tocilizumab was started. She responded favorably with remission of fever, 
arthritis, and skin manifestations and was able to taper corticosteroid therapy 
successfully.