A 40-year old female presented to the emergency room at London Health Sciences Centre with a one week history of gradually progressive right leg weakness which had caused several falls. She also described numbness of the right arm and leg. In the two weeks leading up to admission she experienced gradually worsening shortness of breath, fatigue, anorexia, confusion, night sweats and somnolence. She also developed a herpetic rash of the right upper thigh which was treated with acyclovir and gabapentin.
Her past medical history was significant for a diagnosis of systemic lupus erythematosis (SLE) for seven years, treated at the time of admission with azathioprine 50 mg TID (several years duration), prednisone 5 mg BID, and hydroxyquine 400 mg daily. She also had a history of asthma and occasionally required Ventolin treatment. She had a 25 pack-year smoking history.