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

A 54-year-old female was admitted to our clinic for the evaluation of proteinuria and pancytopenia.By immunological examination and renal histology, she was diagnosed as systemic lupus erythematosus.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.About 110 days after admission, hallucination and delusion have developed gradually and persisted despite several therapeutic attempts.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.In post mortal pathological observation, multiple hemorrhagic infarction-like lesions, up to thumb-head size, were noticed in the medulla of cerebrum and cerebellum.Infiltrations of atypical lymphoid malignant cells were seen in these lesion, but neither evidence of vasculitis or infarction was present at all.Since there were no infiltration of such pathological cells in systemic lymphnodes, the diagnosis of primary malignant lymphoma of the brain has been determined.Both listeriosis and primary malignant lymphoma of the brain can be seen rather frequently in immunodeficient patients such as transplant recipients with immunosuppressants.Several cases of SLE with one of these complications have been occasionally reported.However, simultaneous complication of both listeriosis and primary malignant lymphoma of the brain is very rare in SLE patients.The pathogenesis of the development of these complications in this case was discussed.