Case report
We report the case of a 16 year old girl diagnosed with proliferative
and membranous lupus nephritis 4 years ago. She had also history of
PRESS syndrome at the time of diagnosis of SLE. She was treated with 6
pulses of Cyclophosphamide with a total dose of 3 g and 3 pulses of
Methylpredisolone as induction therapy followed by Mycophenolate Mofetil
1,5 g daily and Hydoxychloroquine 200 mg for the maintain therapy. A
partial remission was obtained after 1 year of treatment. An impairment
of kidney function was observed after 3 years of follow up and renal
biopsy showed severe tubulointerstitial lesions. On February 2020, she
was admitted to our department with symptoms of vomiting, weight loss
and strabismus. Physical examination showed normal blood pressure, right
hemiparesis, non-deficient quadripyramidal syndrome and strabismus of
the right eye. Laboratory tests revealed blood count cell of 11880/mm,
hemoglobin: 9,8g/ dl, platelets: 340000/mm, C-reactive protein was
negative. Magnetic resonance imaging (MRI) of the brain demonstrated
infiltrative hyperintense mass expanding genu and trunk of corpus
callosum (Fig.1a). A stereotactic biopsy diagnosed diffuse large B-cell
lymphoma (Fig.1.b). MMF was discontinued. She was started on
chemotherapy and she underwent whole radiotherapy.