Kienbock's disease, or radiologic avascular necrosis (AVN) of the carpal lunate, is an uncommon disease of young adults. The precise etiological mechanisms are uncertain although multiple mechanical, anatomical, and vascular factors are thought to be involved. A patient with systemic lupus erythematosus (SLE) who developed bilateral Kienbock's disease during the course of her illness was reported. A vasculopathy related to active vasculitis or the antiphospholipid antibodies was thought to be responsible.