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

doi:10.2176/nmc.43.43

Case Reports

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

Author information

Joji INAMASU
Department of Neurosurgery, National Tokyo Medical Center
Yoshiki NAKAMURA
Department of Neurosurgery, National Tokyo Medical Center
Ryoichi SAITO
Department of Neurosurgery, National Tokyo Medical Center
Yoshiaki KUROSHIMA
Department of Neurosurgery, National Tokyo Medical Center
Keita MAYANAGI
Department of Neurosurgery, National Tokyo Medical Center
Shigeo OHBA
Department of Neurosurgery, National Tokyo Medical Center
Masahiko NISHIKAI
Department of Internal Medicine, National Tokyo Medical Center
Kazunori KOYAMA
Department of Internal Medicine, National Tokyo Medical Center
Kiyoshi ICHIKIZAKI
Department of Neurosurgery, National Tokyo Medical Center

Keywords: brain abscess, CA19-9, diffusion-weighted magnetic resonance imaging, metastatic brain tumor, systemic lupus erythematosus

JOURNAL OPEN ACCESS

2003 Volume 43 Issue 1 Pages 43-46

DOI https://doi.org/10.2176/nmc.43.43

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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.

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