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An unusual cause of meningitis

T M Pasha1, K Trower, D Bhatia

  • 1SHO, General Medicine, Hull Royal Infirmary.

Acute Medicine
|June 10, 2011
PubMed

Insights

A patient with rheumatoid arthritis developed fever and headache after returning from the USA. His swollen elbow indicated a potential infection or inflammatory flare.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • A 57-year-old male with sero-positive rheumatoid arthritis, managed with disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and leflunomide.
  • The patient had a recent travel history, residing in Massachusetts, USA for one year, returning six months prior to presentation.

Purpose of the Study:

  • To investigate the cause of fever and frontal headache in an immunocompromised patient.
  • To evaluate the differential diagnosis for a swollen, tender elbow in the context of rheumatoid arthritis and recent travel.

Main Methods:

  • Clinical presentation review including patient history and physical examination findings.
  • Assessment of vital signs and specific joint examination, focusing on the left elbow.

Main Results:

  • Patient presented with fever and frontal headache, with a history of rheumatoid arthritis on immunosuppressive therapy.
  • Physical examination revealed a warm, tender, and swollen left elbow joint; other findings were within normal limits.

Conclusions:

  • The patient's symptoms suggest a possible infectious process or an inflammatory flare of rheumatoid arthritis.
  • Further investigations are warranted to determine the etiology of the fever, headache, and elbow joint swelling.

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