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Induction and Clinical Scoring of Chronic-Relapsing Experimental Autoimmune Encephalomyelitis
Published on: July 4, 2007
[Steroid responsive chronic meningoencephalitis reminiscent of rheumatoid meningitis: a case report]
Satoru Morimoto1, Masaki Takao, Keita Sakurai
1Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology.
Abstract:
A 62-year-old woman presented at our hospital with a headache, cognitive decline, and fever that had persisted for 3 months. On admission, fever, headache, and mild cognitive dysfunction were all clearly evident, suggesting chronic meningoencephalitis. Laboratory examination showed mild neutrophilia as well as an increase in her erythrocyte sedimentation rate and serum C-reactive protein levels. MRI showed multiple small hyperintense lesions on T2 weighted image and diffusion weighted image (DWI) in the cerebral cortex and white matter. Contrast-enhanced T1 weighted image showed the abnormal pial enhancement along the cerebral sulci. Systemic evaluations for infectious organisms, autoantibodies, and malignant tumors were all negative. Her fever and neurological symptoms continued. As a result of worsening MRI findings, a brain biopsy was carried out. Neuropathological analysis revealed neutrophilic infiltration in the subarachnoid space and multinucleated giant cells. However, there was no vasculitis on the histological sections. This pathological finding was reminiscent of rheumatoid meningitis despite articular findings of rheumatoid arthritis, as well as rheumatoid factor (RF) and anti-CCP antibody tests being negative. After oral steroid therapy, her fever and inflammatory reactions by laboratory test diminished and her cognitive function improved remarkably.
Insights
This case highlights a rare instance of chronic meningoencephalitis mimicking autoimmune conditions. Prompt steroid therapy led to significant improvement in neurological symptoms and inflammatory markers.
Area of Science:
- Neurology
- Neuroinflammation
- Rheumatology
Background:
- Chronic meningoencephalitis presents diagnostic challenges, often mimicking autoimmune or infectious etiologies.
- Distinguishing inflammatory neurological disorders requires comprehensive evaluation, including advanced neuroimaging and histopathology.
- The case underscores the importance of considering less common presentations of inflammatory conditions.
Observation:
- A 62-year-old woman presented with a 3-month history of persistent fever, headache, and cognitive decline.
- MRI revealed multiple cerebral lesions and pial enhancement, suggestive of meningoencephalitis.
- Brain biopsy showed neutrophilic infiltration and multinucleated giant cells, without vasculitis.
Findings:
- Neuropathological findings were suggestive of rheumatoid meningitis, despite negative rheumatoid factor and anti-CCP antibodies.
- Systemic workup for infections, autoimmune diseases, and malignancy yielded negative results.
- The patient's symptoms persisted despite initial negative workups, necessitating a brain biopsy.
Implications:
- This case expands the differential diagnosis for chronic meningoencephalitis, particularly concerning atypical inflammatory presentations.
- Early recognition and treatment with corticosteroids can lead to remarkable recovery in similar complex neurological cases.
- Further research into the pathogenesis of non-vasculitic inflammatory meningitis is warranted.
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