Vol.21 No.5

Case Report

Histopathological analysis of cerebral hemorrhage in systemic lupus erythematosus complicated with antiphospholipid syndrome

Authors

Yoshiyuki Arinuma1 , Hirotoshi Kikuchi2 , Kaori Aramaki2 , Masahisa Kyogoku3 , Shunsei Hirohata4

  • Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, 252-0392, Japan
  • Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, 173-8605, Japan
  • Department of Pathology, Tohoku University School of Medicine, Sendai, Miyagi, 980-8575, Japan
  • Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
Received:

14 October 2010

Accepted:

17 January 2011

Published online:

13 February 2011

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Abstract

A 53-year-old woman was admitted due to akinetic mutism and fever. On admission, brain computed tomography (CT) scan revealed a large hemorrhagic lesion in the left anterior lobe that required surgical operation for total removal. Her neuropsychiatric manifestation was not attenuated after the operation, and was gradually ameliorated by high doses of corticosteroid thereafter, suggesting a diagnosis of lupus psychosis. Histopathological examination revealed a necrotizing vasculature, sometimes with a disrupted lamina elastica interna, completely filled with thrombi and infiltrated with inflammatory cells and their debris. It is therefore suggested that the large frontal lobe hematoma in our patient was induced by thrombosis and arteritis in the subarachnoid space.

Key words

Antiphospholipid syndrome - Cerebral hemorrhage - Systemic lupus erythematosus - Lupus psychosis - Thrombosis - Arteritis