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.