We did not find serologic evidence of syphilis on testing, nor did the patient travel to an area in which Lyme disease is endemic. Tuberculosis could explain some of the multisystem findings and evidence for chronic meningeal inflammation, but the appearance of diffuse white matter abnormalities would be unusual, and no growth of acid-fast bacilli was evident from a previous bronchoscopic study. In the presence of higher clinical suspicion, however, a single negative bronchoscopic study would not rule out mycobacterial infection. Given the above considerations, this patient's chronic anemia, immunoglobulin studies, protein electrophoresis, elevated erythrocyte sedimentation rate, and depressed complement levels increased the clinical concern for an active inflammatory process. While it is rarely the presenting symptom, it usually occurs within 1 year of a definite diagnosis of disease.
Neurologic involvement is more common in patients with antiphospholipid antibody syndrome.
The most common symptoms are headache and peripheral neuropathy. True CNS vasculitis, while often discussed, is relatively rare and was not classified as a distinct syndrome by the American College of Rheumatology's Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature. The pathological correlates of neuropsychiatric lupus are often mild and nonspecific. Bland vasculopathy, characterized by vascular hyalinization, vessel tortuosity, endothelial proliferation and perivascular gliosis are probably the most common findings on biopsy, but are nonspecific. Perivascular cuffing of arterioles or venules with inflammatory cells may be seen, but these findings are rare.