In patients with systemic lupus erythematosus (SLE) avascular osteonecrosis can occur either because of a complication of treatment or association with antiphospholipid antibody (APA). In this report, a patient with SLE who developed avascular osteonecrosis is presented. A fourteen year old girl with class 4 SLE nephritis and positive APA had the complaint of hip pain at the 9' month of her treatment. Radiographic investigations and bone scan revealed bilateral avascular osteonecrosis of femoral heads and the patient underwent bilateral hip artroplasty. We emphasized that the patients with SLE who received high dose steroid and had positive APA, can develop osteonecrosis. Early diagnosis is important for treatment. In addition to conventional methods, bone scan is valuable in early recognition.