A 63-year-old woman with a history of hypothyroidism and rheumatoid arthritis was referred to the internal medicine department due to progressive muscle fatigue, weight loss of 15 kg, haemolytic anaemia, fever and memory impairment. The Mini-Mental State Examination was abnormal (MMSE 16/30). The initial brain MRI showed general cortical atrophy and FDG PET suggested a neurodegenerative disease with symmetrical severe hypometabolism in the frontal, parietal and temporal cortexes. Neurological consultation did not lead to a specific diagnosis. Later antinuclear antibody serological tests were indicative of systemic lupus erythematosus (SLE) [1–5]. The patient was treated with high-dose corticosteroids and cyclophosphamide.

After 18 months the brain scans were controlled. Anatomical and metabolic brain findings had normalized, confirming that the observed hypometabolism and atrophy were indeed related to brain manifestation of SLE and, importantly, could be reversed by efficient treatment. Cognitive performance on neuropsychological tests had also recovered. Automated comparison of the FDG PET images to a normal population with the 3D-SSP program shows the dramatic treatment effect in z-score images of surface projections.

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