Rheumatoid meningitis sine arthritis

Area of Science:

• Neurology
• Rheumatology
• Pathology

Background:

• Rheumatoid meningitis is a rare but severe neurological complication of rheumatoid arthritis.
• It typically occurs in patients with a known history of rheumatoid arthritis.

Observation:

• A 70-year-old female presented with stroke-like symptoms, seizures, psychosis, and compulsive behavior.
• Brain MRI revealed progressive interhemispheric meningeal thickening.
• Cerebrospinal fluid analysis showed mild lymphocytic pleocytosis, and high titers of anti-cyclic citrullinated peptide antibodies were detected.

Findings:

• Brain biopsy confirmed necrotizing granulomas, indicative of rheumatoid meningitis.
• The patient had no prior history of arthritis.
• Symptoms resolved with glucocorticoids and cyclophosphamide treatment.

Implications:

• Rheumatoid meningitis should be considered in patients presenting with aseptic meningitis and neurological symptoms, even without a prior rheumatoid arthritis diagnosis.
• This case highlights the importance of a broad differential diagnosis in complex neurological presentations.
• Prompt diagnosis and treatment can lead to symptom resolution and improved patient outcomes.