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Rheumatoid meningitis: successful remission with rituximab
Nancy Salloum Harrison1, Shweta Kishore1, Vikas Majithia1
1Department of Rheumatology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Abstract:
A 53-year-old male with rheumatoid arthritis presented with recurrent headaches, seizures and right-sided lower extremity paralysis while on antiepileptic medications. Work up revealed pachymeningeal and leptomeningeal enhancement on brain MRI. Differential diagnosis included a variety of infections, neoplasm and vasculitis. Histopathology showed findings consistent with rheumatoid meningitis (RM). Ultimately based on symptoms, MRI findings and tissue pathology, he was diagnosed with RM. Intravenous pulse dose steroids were initiated followed by rituximab every 6 months, resulting in significant improvement of the brain MRI findings. Patient has remained seizure free.
Insights
Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis. This case highlights RM diagnosis in a patient with neurological symptoms and MRI findings, successfully treated with steroids and rituximab.
Area of Science:
- Neurology
- Rheumatology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease.
- Neurological complications of RA are uncommon but can be severe.
- Rheumatoid meningitis (RM) is a rare manifestation of RA.
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