Rheumatoid Meningitis: A Case Review

Area of Science:

• Neurology
• Rheumatology
• Immunology

Background:

• Rheumatoid meningitis (RM) is a rare but serious complication of rheumatoid arthritis (RA).
• RM can manifest across various stages of RA, including well-controlled disease.
• Neurological presentations of RM are diverse and can be challenging to diagnose.

Observation:

• A patient with a 30-year history of rheumatoid arthritis (RA) presented with new-onset seizures.
• Magnetic resonance imaging (MRI) revealed leptomeningeal and pachymeningeal enhancement.
• The clinical presentation and imaging findings led to a diagnosis of RM.

Findings:

• Cerebrospinal fluid analysis in RM is often nonspecific, showing lymphocytic or, atypically, neutrophilic pleocytosis.
• MRI findings commonly include leptomeningeal and pachymeningeal enhancement, with potential parenchymal involvement.
• Meningeal biopsy is typically required for definitive diagnosis of RM.

Implications:

• Prompt diagnosis and treatment of RM are critical due to its high mortality rate.
• Treatment strategies for RM include high-dose corticosteroids and/or immunomodulatory therapy.
• Long-term follow-up with radiologic surveillance is essential for monitoring treatment response and disease resolution.