Ring-enhanced mass in the brain of a woman with systemic lupus erythematosus and elevated serum CA19-9 level: Brain abscess or metastatic tumor? - Case report

Joji Inamasu, Yoshiki Nakamura, Ryoichi Saito, Yoshiaki Kuroshima, Keita Mayanagi, Shigeo Ohba, Masahiko Nishikai, Kazunori Koyama, Kiyoshi Ichikizaki

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Abstract

A 70-year-old woman with systemic lupus erythematosus presented with a brain abscess manifesting as progressive monoparesis of the right lower extremity over 4 days. She had had no episodes of fever, and did not complain of headache or exhibit any signs of meningeal irritability. Computed tomography of the brain showed a round, low-density mass with strong ring enhancement in the left frontal lobe. Laboratory examination found a moderately elevated serum level of CA19-9, a marker of some digestive organ cancers. Together with the absence of febrile episodes, headache, and a rise in leukocyte count, the initial suspicion was metastatic brain tumor rather than brain abscess. However, diffusion-weighted magnetic resonance imaging depicted the mass as a very hyperintense area. The neuroimaging diagnosis was brain abscess. After conservative treatment with intravenous antibiotics for 6 weeks, the brain abscess completely resolved, and the patient was discharged without neurological deficits.

Original languageEnglish
Pages (from-to)43-46
Number of pages4
JournalNeurologia medico-chirurgica
Volume43
Issue number1
DOIs
Publication statusPublished - 01-01-2003

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All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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