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Multiple Cerebral Infarctions as an Initial Manifestation of Systemic Lupus Erythematosus with Concomitant Hypereosinophilic Syndrome

Akihiro Nakamura, Tomoya Miyamura, Brian Wu and Eiichi Suematsu

A 51-year old woman with drowsy consciousness and weakness in bilateral upper and lower extremities was admitted to our hospital. Laboratory test on admission showed eosinophilia, proteinuria, hypoalbuminemia, and elevated creatine kinase-MB. She also had positive antinuclear antibody, anti-ribonucleoprotein antibody and anti- Smith antibody as well as decreased levels of complements. Brain MRI showed multiple cerebral infarcts in both hemispheres. Renal biopsy determined class IV lupus nephritis. Vasculopathy and hypercoagulopathy induced by systemic lupus erythematosus rarely concomitant with hypereosinophilic syndrome were considered as main causes of multiple cerebral infarctions in this patient. The symptoms and laboratory data were gradually recovered with an intravenous methylprednisolone pulse therapy followed by oral prednisolone and monthly intravenous cyclophosphamide therapies.