Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Overlap syndrome of systemic lupus erythematosus and dermatomyositis presented a large demyelinating subcortical lesion mimicking brain tumor and high level of CSF antineuronal and serum anti-ribosomal P antibodies

Satoko Kano, M. D. 1), Tomoki Nakamori, M. D. 1), Ichiro Imafuku, M. D. 1), Akira Sudo, M. D. 2), Shigeo Inomori, M. D. 3), Shigeo Murayama, M. D. 4) and Masanari Kunimoto, M. D. 1)

1)Department of Neurology, Yokohama Rosai Hospital
2)Department of Internal Medicine, Yokohama Rosai Hospital
3)Department of Neurosurgery, Yokohama Rosai Hospital
4)Department of Neuropathology, Tokyo Metropolitan Institute of Geriatrics

We reported a 50-year-old man with an overlap syndrome of dermatomyositis and SLE, whose magnetic resonance image of the brain showed a rapidly increasing large tumor-like focal lesion unequally enhanced by Gd-DTPA in the left frontal lobe. Its pathological finding by the brain biopsy was fibrinoid necrosis, inflammatory cell aggregation around blood vessels and many myelin-laden macrophages with central necrosis. Although many cases of blood vessel injury are reported in CNS lupus, in this case the brain lesion partly took reversible course and neural symptoms such as paresis were slight and the lesion well responded to steroid. Moreover we considered that the measurement of serum anti-ribosomal P and CSF antineuronal antibodies are useful to diagnose cases as CNS lupus.

(CLINICA NEUROL, 42: 197|201, 2002)
key words: systemic lupus erythematosus, dermatomyositis, demyelination, antineuronal antibody, anti-ribosomal P antibody

(Received: 9-Mar-01)