Simultaneous calcified and noncalcified fibrotic splenic nodules in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a systemic inflammatory disease caused by aberrant immune responses, leading to autoantibody production and multiorgan involvement. Splenic lesions in SLE have been reported to include splenomegaly, splenic calcification, and splenic infarction, but reports of multiple splenic nodules are rare. In this case report and literature review, we describe a 47-year-old male patient with a history of SLE in remission for 25 years presenting multiple calcified and noncalcified nodules in the spleen, which were incidentally detected during a routine health check-up. On computed tomography, the nodules showed focal calcification. On magnetic resonance imaging, they showed hypointensity on T2-weighted imaging and gradual delayed enhancement on dynamic contrast-enhanced imaging, suggesting a fibrotic nature. However, a definitive diagnosis was not established. The patient underwent splenectomy for both diagnostic and therapeutic purposes. Histopathological examination revealed fibrous nodules with onion-skin lesions, which were pathologically characteristic of SLE. No recurrence has been observed to date. In the present case, subtle calcification was observed within a portion of the intrasplenic fibrous nodules, suggesting that this case may represent a possible transitional stage in the development of the intrasplenic calcified nodules associated with SLE. We also present a literature review and discuss this pathology.