Diffuse Leukoencephalopathy and Subacute Parkinsonism as an Early Manifestation of Systemic Lupus Erythematosus
50-year-old male presenting with diffuse, confluent leukoencephalopathy and subacute parkinsonism. Axial brain MRI FLAIR sequence on initial presentation showing extensive confluent symmetric hyperintensities ((a) and (b)). Gross skin punch biopsy from right knee (c) shows superficial ((d), arrows) and deep perivascular dermatitis ((e), arrows) with focally increased dermal mucin highlighted by Alcian blue stain (f). Repeat axial brain MRI FLAIR sequence after 5 months demonstrating radiographic improvement following immunosuppressive therapy ((g) and (h)).
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