[Probable rheumatoid meningitis complicated by cryptococcal meningitis: A case report].

Area of Science:

• Neurology
• Rheumatology
• Infectious Diseases

Background:

• Rheumatoid arthritis (RA) is an autoimmune disease that can affect various organs.
• Meningitis, inflammation of the meninges, can be caused by infections or autoimmune conditions.
• Co-occurrence of rheumatoid meningitis and infectious meningitis is rare.

Observation:

• A 59-year-old female with RA presented with migraine, abnormal behavior, fever, and headache.
• Cerebrospinal fluid (CSF) analysis revealed elevated cells and protein, with high anti-cyclic citrullinated peptide (CCP) antibodies.
• Brain MRI showed leptomeningeal enhancement, suggestive of rheumatoid meningitis.

Findings:

• The patient was initially treated for probable rheumatoid meningitis with prednisolone (PSL) pulses.
• Cryptococcus neoformans was subsequently identified in CSF, leading to treatment with liposomal-amphotericin B (L-AMB).
• Recurrence of meningitis symptoms correlated with increased anti-CCP antibodies, indicating a primary role of rheumatoid meningitis in pathogenesis.

Implications:

• This case highlights the importance of considering concurrent autoimmune and infectious meningitis in RA patients.
• Aggressive immunosuppression for rheumatoid meningitis may increase susceptibility to opportunistic infections like cryptococcal meningitis.
• Long-term management requires balancing immunosuppression for RA with targeted antimicrobial therapy and monitoring for recurrence.