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Doherty et al have recently reported in this journal on a case of Hashimoto’s encephalopathy clinically mimicking Creutzfeldt–Jakob disease.1 As neuropathological analysis of a brain biopsy in this case revealed spongiform change and sparse mononuclear infiltrates in perivascular spaces, the authors suggested that Hashimoto’s encephalopathy is an encephalitic process. We have previously described a necropsy case of Hashimoto’s encephalopathy showing lymphocytic vasculitis of veins and venules of the brain stem, supporting the hypothesis that vasculitis represents the morphological substrate of Hashimoto’s encephalopathy.2 Doherty et al have challenged our diagnosis and stated that the term vasculitis should be reserved for lesions with inflammation and fibrinoid necrosis of arterial vessels.
Lymphocytic vasculitis is a generally accepted pathological subtype covered by reviews and standard textbooks.3,4 It is characterised by the presence of lymphocytes within the vessel wall and is encountered in Wegener’s disease, systemic lupus erythematosus, and Behcet’s disease, to name but a few conditions.4 That the diagnosis is more difficult than for necrotising arteritis does not, however, imply that lymphocytic vasculitis does not exist, …