Rheumatoid meningitis in the absence of rheumatoid arthritis: 2 cases.
Rheumatoid arthritis
Rheumatoid meningitis
Unilateral limb weakness
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
15 Jul 2024
15 Jul 2024
Historique:
received:
03
02
2024
accepted:
03
07
2024
medline:
16
7
2024
pubmed:
16
7
2024
entrez:
15
7
2024
Statut:
epublish
Résumé
Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA) that has been increasingly recognized by neurologists. However, the diversity of its clinical manifestations makes its diagnosis difficult. RM does not have a unified diagnostic standard, and its link with RA needs to be studied further. Here we report two cases of RM without a history of RA. The first patient, an 80-year-old woman, presented with sudden unilateral limb weakness, with brain MR showing abnormal signals in the leptomeningeal of the right frontal parietal. Subarachnoid hemorrhage was excluded after imaging examination, and infectious meningitis was ruled out after cerebrospinal fluid (CSF) examination. The patient was diagnosed as having RM, she had increased levels of CCP and AKA, the markers of RA, but no history of the disease or other clinical manifestations of it. Another case, a 65-year-old man, was hospitalized with Bell's palsy. We found that he had intracranial imaging changes highly consistent with those characteristic of RM during his routine examination. Except for the left peripheral facial palsy, the patient had no other neurological signs or symptoms and no RA history. After a careful physical examination, we found no joint or other manifestations or serological abnormalities consistent with RA (RF, CCP, AKA, etc.). However, after excluding infection meningitis and considering the patient's unique imaging results, we diagnosed him as having RM. We report these two cases as references for clinical diagnosis and treatment of RM, providing a discussion of our rationale.
Identifiants
pubmed: 39009960
doi: 10.1186/s12883-024-03751-8
pii: 10.1186/s12883-024-03751-8
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
243Subventions
Organisme : the 2021 Innovation and Entrepreneurship Project for Returned Overseas Researchers in Ningxia, China and the Foundation of Ningxia Medical University .
ID : grant number: 352. XM2022029.
Informations de copyright
© 2024. The Author(s).
Références
Ouyang R, Mitchell DM, Rozdilsky B. Central nervous system involvement in rheumatoid disease. Rep case [J] Neurol. 1967;17(11):1099–105.
Spurlock RG, Richman AV. Rheumatoid meningitis. A case report and review of the literature [J]. Arch Pathol Lab Med. 1983;107(3):129–31.
pubmed: 6687527
Mckenna MC, Vaughan D, Bermingham N et al. Rheumatoid arthritis presenting as rheumatoid meningitis [J]. BMJ case Rep, 2019, 12(1).
Guevara C, Villa E, Núñez R, et al. Rheumatoid meningitis: report of two cases [J]. Rev Med Chil. 2021;149(2):295–303.
doi: 10.4067/s0034-98872021000200295
pubmed: 34479278
Chowdhry V, Kumar N, Lachance DH, et al. An unusual presentation of rheumatoid meningitis [J]. J Neuroimaging: Official J Am Soc Neuroimaging. 2005;15(3):286–8.
doi: 10.1111/j.1552-6569.2005.tb00325.x
Lee Ching C, Kenyon L, Berk M, et al. Rheumatoid meningitis sine arthritis [J]. J Neuroimmunol. 2019;328:73–5.
doi: 10.1016/j.jneuroim.2018.12.001
pubmed: 30597393
Aguilar-Amat MJ, Abenza-Abildúa MJ, Vivancos F, et al. Rheumatoid meningitis mimicking progressive supranuclear palsy [J]. Neurologist. 2011;17(3):136–40.
doi: 10.1097/NRL.0b013e31821735ad
pubmed: 21532380
Pellerin D, Wodkowski M, Guiot MC, et al. Rheumatoid meningitis presenting with Acute parkinsonism and protracted non-convulsive seizures: an unusual case presentation and review of treatment strategies [J]. Front Neurol. 2019;10:163.
doi: 10.3389/fneur.2019.00163
pubmed: 30873111
pmcid: 6400852
Roques M, Tanchoux F, Calvière L, et al. MRI with DWI helps in depicting rheumatoid meningitis [J]. J Neuroradiol = J de Neuroradiologie. 2014;41(4):275–7.
doi: 10.1016/j.neurad.2013.10.005
Matsushima M, Yaguchi H, Niino M, et al. MRI and pathological findings of rheumatoid meningitis [J]. J Clin Neuroscience: Official J Neurosurgical Soc Australasia. 2010;17(1):129–32.
doi: 10.1016/j.jocn.2009.01.033
Nesbitt C, Willshire L, Quan D, et al. Leptomeningeal rheumatoid nodules: diagnosis and failed therapeutics [J]. J Clin Neuroscience: Official J Neurosurgical Soc Australasia. 2015;22(2):425–8.
doi: 10.1016/j.jocn.2014.07.031
Cianfoni A, Falcone C, Faustini F, et al. Rheumatoid leptomeningitis: magnetic resonance imaging and pathologic findings–a case report [J]. J Neuroimaging: Official J Am Soc Neuroimaging. 2010;20(2):192–4.
doi: 10.1111/j.1552-6569.2008.00299.x
Ikeda K, Takazawa T, Ito H, et al. Rheumatoid leptomeningitis: radiological alteration of cerebral hypoperfusion and subarachnoid lesions [J]. Intern Med (Tokyo Japan). 2010;49(17):1911–6.
doi: 10.2169/internalmedicine.49.3492
Aktan Suzgun M, Erener N, Cavus GH, et al. A review of rheumatoid meningitis with case studies [J]. Mod Rheumatol case Rep. 2023;7(2):340–6.
doi: 10.1093/mrcr/rxad010
pubmed: 36718604
Villa E, Sarquis T, De Grazia J, et al. Rheumatoid meningitis: a systematic review and meta-analysis [J]. Eur J Neurol. 2021;28(9):3201–10.
doi: 10.1111/ene.14904
pubmed: 33966315
Yuh WT, Drew JM, Rizzo M, et al. Evaluation of pachymeningitis by contrast-enhanced MR imaging in a patient with rheumatoid disease [J]. AJNR Am J Neuroradiol. 1990;11(6):1247–8.
pubmed: 2124068
pmcid: 8332151
Qin Z, Kim J, Valencia D, et al. Rheumatoid meningitis: a case report and review of the literature [J]. Neurol Clin Pract. 2020;10(1):73–83.
doi: 10.1212/CPJ.0000000000000678
pubmed: 32190423
pmcid: 7057072
PARSONS A M, ASLAM F, GRILL M F, et al. Rheumatoid meningitis: clinical characteristics, diagnostic evaluation, and treatment [J]. Neurohospitalist. 2020;10(2):88–94.
doi: 10.1177/1941874419859769
pubmed: 32373270
Wang XP, Cheng QY, Gu MM, et al. Diagnostic accuracy of anti-keratin antibody for rheumatoid arthritis: a meta-analysis [J]. Clin Rheumatol. 2019;38(7):1841–9.
doi: 10.1007/s10067-019-04464-x
pubmed: 30810911
Bas S, Genevay S, Meyer O, et al. Anti-cyclic citrullinated peptide antibodies, IgM and IgA rheumatoid factors in the diagnosis and prognosis of rheumatoid arthritis [J]. Rheumatology (Oxford). 2003;42(5):677–80.
doi: 10.1093/rheumatology/keg184
pubmed: 12709545
Rantapää-Dahlqvist S, De Jong BA, Berglin E, et al. Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis [J]. Arthritis Rheum. 2003;48(10):2741–9.
doi: 10.1002/art.11223
pubmed: 14558078
Derksen V, Huizinga TWJ, van der Woude D. The role of autoantibodies in the pathophysiology of rheumatoid arthritis [J]. Semin Immunopathol. 2017;39(4):437–46.
doi: 10.1007/s00281-017-0627-z
pubmed: 28451788
pmcid: 5486798
Bathon JM, Moreland LW, Dibartolomeo AG. Inflammatory central nervous system involvement in rheumatoid arthritis [J]. Semin Arthritis Rheum. 1989;18(4):258–66.
doi: 10.1016/0049-0172(89)90047-4
pubmed: 2658068
Rodriguez Alvarez M, Rodríguez Valencia LM, Seidman R, et al. Rheumatoid meningitis and infection in absence of rheumatoid arthritis history: review of 31 cases [J]. Clin Rheumatol. 2020;39(12):3833–45.
doi: 10.1007/s10067-020-05221-1
pubmed: 32519051
Fan S, Zhao J, Hou B, et al. Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis [J]. Front Immunol. 2023;14:1065650.
doi: 10.3389/fimmu.2023.1065650
pubmed: 37350975
pmcid: 10282747