リステリア症,頭蓋内原発悪性リンパ腫を合併し,著しい精神症状を呈した全身性エリテマトーデスの1例

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  • A case of systemic lupus erythematosus complicated with listeriosis and primary malignant lymphoma of the brain

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A 54-year-old female was admitted to our clinic for the evaluation of proteinuria and pancytopenia.<br>By immunological examination and renal histology, she was diagnosed as systemic lupus erythematosus.<br>On twenty hospital days, high fever, nuchal stiffness and consciousness disturbance appeared, and she was diagnosed as being complicated with meningitis of Listeria monocytogenes by the cerebrospinal fluids examination.<br>About 110 days after admission, hallucination and delusion have developed gradually and persisted despite several therapeutic attempts.<br>Grand mal-like convulsion and anisocoria appeared suddenly about one year after admission, then she took a down hill course and died of cardiorespiratory failure on May 19 1982.<br>In post mortal pathological observation, multiple hemorrhagic infarction-like lesions, up to thumb-head size, were noticed in the medulla of cerebrum and cerebellum.<br>Infiltrations of atypical lymphoid malignant cells were seen in these lesion, but neither evidence of vasculitis or infarction was present at all.<br>Since there were no infiltration of such pathological cells in systemic lymphnodes, the diagnosis of primary malignant lymphoma of the brain has been determined.<br>Both listeriosis and primary malignant lymphoma of the brain can be seen rather frequently in immunodeficient patients such as transplant recipients with immunosuppressants.<br>Several cases of SLE with one of these complications have been occasionally reported.<br>However, simultaneous complication of both listeriosis and primary malignant lymphoma of the brain is very rare in SLE patients.<br>The pathogenesis of the development of these complications in this case was discussed.

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