Central nervous system lymphoma associated with mycophenolate mofetil in lupus nephritis

Abstract

Lymphomas, both within and outside the central nervous system, are uncommon among patients with systemic lupus erythematosus (SLE). We describe a 58-year old Korean woman with SLE who presented with acute headache and confusion in the setting of prednisone and mycophenolate mofetil (MMF) therapy used to treat focal proliferative and membranous lupus nephritis. Three-dimensional brain magnetic resonance imaging (MRI) showed two peripherally (‘ring’) enhancing lesions within the basal ganglia, bilaterally, with associated mass effect and subfalcine herniation. A brain biopsy revealed an Epstein-Barr virus (EBV)-positive diffuse large B cell lymphoma. This is the first description of CNS lymphoma in a patient treated with MMF for lupus nephritis. While intracerebral lymphoma in the immunocompromised patient with lupus is rare, this disorder should be considered in the differential diagnosis of new-onset neurological symptoms among such patients.

Keywords

central nervous system lymphoma immunosuppression lupus nephritis mycophenolate mofetil systemic lupus erythematosus

Get full access to this article

View all access options for this article.

References

Houssiau FA. Management of lupus nephritis: an update . J Am Soc Nephrol 2004; 10: 2694-2704 .

Chan TM , Li FK , Tang CS et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis . N Engl J Med 2000; 343: 1156-1162 .

Contreras G , Pardo V , Leclercq B et al. Sequential therapies for proliferative lupus nephritis . N Engl J Med 2004; 350: 971-980 .

US Renal Transplant Mycophenolate Mofetil Study Group . Mycophenolate mofetil in cadaveric renal transplantation . Am J Kidney Dis 1999; 34: 296-303 .

Snanoudj R , Durrbach A , Leblond V et al. Primary brain lymphomas after kidney transplantation: presentation and outcome . Transplantation 2003; 76: 930-937 .

Waldman MA , Callen JP. Self-resolution of Epstein-Barr virus-associated B-cell lymphoma in a patient with dermatomyositis following withdrawal of mycophenolate mofetil and methotrexate . J Am Acad Dermatol 2004; 51(2 Suppl.): S124-S130 .

West SG. Lupus and the CNS . Curr Opin Rheum 1996; 8: 408-414 .

Asherson RA , Khamashta MA , Gil A et al. Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome . Am J Med 1989; 87: 597-597 .

Bjornadal L , Lofstrom B , Yin L et al. Increased cancer incidence in a Swedish cohort of patients with systemic lupus erythematosus . Scand J Rheum 2002; 31: 66-71 .

10.

Kamel OW , van de Rijn M , LeBrun DP , Weiss LM , Warnke RA , Dorfman RF. Lymphoid neoplasms in patients with rheumatoid arthritis and dermatomyositis: frequency of Epstein-Barr virus and other features associated with immunosuppression . Human Pathology 1994; 25: 638-643 .

11.

Tomabechi M , Daita G , Ohgami S , Yonemasu Y , Maekawa I. A case of primary intracerebral malignant lymphoma in systemic lupus erythematosus . No Shinkei Geka 1992; 20: 429-432 .