Case Report: A case of neuropsychiatric lupus with primary central nervous system diffuse large B-cell lymphoma

The coexistence of neuropsychiatric systemic lupus erythematosus (NPSLE) and primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system (CNS) (PCNS DLBCL) is extremely rare in clinical practice. This article retrospectively analyzes the clinical manifestations, imaging examinations, pathological diagnosis, and treatment process of a patient with NPSLE, from the appearance of intracranial abnormal signal shadows to the final diagnosis of PCNS DLBCL.

A 32-year-old Chinese female patient had previously visited our hospital due to vomiting and delirium and was diagnosed with NPSLE. In February 2021, she returned to our hospital with vomiting again. Laboratory tests revealed elevated infection markers and Epstein-Barr virus infection. Brain CT and MRI showed an abnormal intracranial lesion on the left side, which was initially considered to be a brain abscess. After one week of ineffective anti-infection treatment, the patient underwent surgery, during which the lesion was identified as a brain tumor and successfully resected. The final diagnosis was PCNS DLBCL. The patient improved after treatment and was discharged from the hospital. There has been no recurrence of NPSLE or lymphoma within three years.

When patients with NPSLE develop new intracranial lesions, misdiagnosis is likely to occur. Imaging and pathology are crucial, and clarifying the nature of the lesion is conducive to a good long-term prognosis.