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This article discusses an error indicating that SUSDB is inaccessible using Network Services\NT Authority.
Patch Manager 18.104.22.1685
It is often unknown which updates will break WSUS but SUSDB fixes itself when you remote the last patching cycle's updates.
Currently. the latest update that has reconfigured the SUSDB being inaccessible by Network Services\NT Authority is KB3159706. You will need to uninstall this update and reboot your WSUS server.