Article Text
Abstract
Leptomeningitis is a rare central nervous system manifestation of rheumatoid arthritis, generally in patients with established chronic rheumatoid disease. We report a 41-year-old man without previous rheumatoid arthritis or psychiatric disorder who presented with an acute neuropsychiatric disturbance and polyarthralgia. His MR scan of brain showed asymmetric bifrontal leptomeningitis, confirmed on (18F)-fluoro-D-glucose-positron emission tomography. Other investigations showed highly positive serum and cerebrospinal fluid anti-cyclic citrullinated peptide. A leptomeningeal biopsy showed necrotising leptomeningeal inflammation with ill-defined granulomas and lymphoplasmacytic infiltrate without organisms. Prolonged high-dose corticosteroids and then rituximab resulted in recovery. Chronic leptomeningitis can present with an acute neuropsychiatric disorder. We highlight that early rheumatoid disease can, rarely, cause a chronic leptomeningitis, reversible with immunotherapy.
- rheumatoid meningitis
- leptomeningitis
- pachymeningits
- neuropsychiatric disturbance
- rheumatoid arthritis
Statistics from Altmetric.com
Footnotes
Contributors ML was involved in the inpatient management of the patient, study concept, literature review and writing of the manuscript. JS was involved in the reporting of the histopathology, study concept and writing of the manuscript. MB was involved in the reporting of the histopathology, study concept and writing of the manuscript. ASL was involved in the inpatient management of the patient and writing of the manuscript. BR was involved in the inpatient management of the patient and writing of the manuscript. ET was involved in the reporting of MRI imaging and writing of the manuscript. MF was involved in the reporting of PET imaging and writing of the manuscript. NB was involved in the inpatient management of the patient and writing of the manuscript. KM involved in the inpatient management of the patient and writing of the manuscript. GMH was involved in the inpatient management of the patient, study concept, writing of the manuscript and research supervision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed by Desmond Kidd, London, UK.
Read the full text or download the PDF:
Other content recommended for you
- Rheumatoid disease: an unusual cause of relapsing meningoencephalitis
- Rheumatoid meningitis: successful remission with rituximab
- Rheumatoid arthritis presenting as rheumatoid meningitis
- 043 Rheumatoid leptomeningitis: an acute presentation of neuropsychiatric disturbance
- Rheumatoid meningitis can present MRI findings that mimic chronic subdural haematoma
- Rheumatoid meningitis
- Intracranial rheumatoid nodule causing recurrent transient neurological deficits
- Rheumatoid meningitis: a rare cause of unilateral pachymeningitis
- Rheumatoid meningitis: a rare complication of rheumatoid arthritis
- Neurosarcoidosis: clinical manifestations, investigation and treatment