Primary Central Nervous System Lymphoproliferative Disease associated with Administration of Mycophenolate Mofetil : A Case Report

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  • Tsuchiya Ryosuke
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Mishima Kazuhiko
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Sasaki Atsushi
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Homma Taku
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Mizuno Reina
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Uchida Eita
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Shirahata Mitsuaki
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Suzuki Tomonari
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Adachi Junichi
    Department of Neurosurgery, Saitama Medical University International Medical Center
  • Nishikawa Ryo
    Department of Neurosurgery, Saitama Medical University International Medical Center

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Other Title
  • 全身性エリテマトーデス, 関節リウマチ, 間質性肺炎に対してミコフェノール酸モフェチル内服中に発症した頭蓋内リンパ球増殖性疾患の1例
  • ゼンシンセイ エリテマトーデス,カンセツ リウマチ,カンシツセイ ハイエン ニ タイシテ ミコフェノールサン モフェチル ナイフク チュウ ニ ハッショウ シタ ズガイ ナイ リンパキュウ ゾウショクセイ シッカン ノ 1レイ

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Abstract

<p>  A 69-year-old woman was treated with immunosuppressive agents (methotrexate, tacrolimus, cyclosporine, etanercept, adalimumab, azathioprine, and mycophenolate mofetil) for a 30-year history of systemic lupus erythematosus, rheumatoid arthritis, and interstitial pneumonia. She presented to our hospital for evaluation of right-sided hemiparesis. Magnetic resonance imaging revealed a ring-enhanced mass lesion (maximum diameter 36mm) in the left parietal lobe. She was hospitalized for further evaluation and treatment of suspected high-grade glioma, metastatic brain tumor, and malignant lymphoma. We performed subtotal tumor resection, and histopathological evaluation of the resected specimen confirmed diagnosis of diffuse large-cell B-cell lymphoma, an iatrogenic lymphoproliferative disease caused by immunosuppressive drugs. This disorder was attributed to mycophenolate mofetil therapy initiated 1 year before symptom onset. Mycophenolate mofetil therapy was discontinued, and the patient received six cycles of rituximab and local radiation. Iatrogenic lymphoproliferative disease is known to occur during mycophenolate mofetil treatment ; however, primary lymphoproliferative disease of the central nervous system associated with mycophenolate mofetil therapy is rare.</p>

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