Esr, c3, c4, total hemolytic complement are all high, negative ana, malar rash, could it be lupus?

Unlikely!: You have obvious inflammation! complement proteins (c3, c4) and ESR -dependent on fibrinogen, are acute phase reactants, that go up with inflammation. You need a specialist in rheumatology. I am certain you do not have lupus!

Very unlikely: Only a few patients with a malar rash on their cheeks have lupus. You have had appropriate laboratory tests and none are suggestive of lupus except the elevated esr, which is a very nonspecific measure of inflammation. See a dermatologist if you have done already done so.

Dr Mumneh and another doctor agreed