Rare vascular changes in the brain in a case of subacute cutaneous lupus erythematosus.

Histopathological changes in leptomeningeal and cerebral blood vessels in a case of subacute cutaneous lupus erythematosus (SCLE) with the involvement of the central nervous system are presented. A 46-year-old woman died because of cerebral stroke after a 19-year duration of the disease. The general autopsy showed changes in the kidneys, myocardium, spleen and pancreas, typical of systemic lupus erythematosus. The brain autopsy revealed large necrosis in the supply territory of the middle and posterior cerebral arteries in the left hemisphere. In addition, small focal necroses, partially hemorrhagic, were found in both cerebellar hemispheres. Small cortical necrosis was also visible in the right insular area. A diffuse damage of the blood vascular system in the form of fibrinoid necrosis of small sized cerebral blood vessels with inflammatory infiltrates of the vessel wall (necrotizing leukocytoclastic vasculitis) predominated in the microscopic examination of the brain. Vascular changes of vasculopathy type in the form of hyalinization of the vascular wall and fibrinoid necrosis with concomitant numerous, small necroses were observed. In the lumen of left internal carotid artery infiltrated by inflammatory cells, an organized thrombus was found. Giant cells were observed within vascular infiltration.