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Unusual Clinical Course in a Case with Relapsing Polychondritis Showing Hypertrophic Pachymeningitis Complicated by a

Ken Yasuda1, Takakuni Maki1, Kohei Nishimura1

  • 1Department of Neurology, Graduate School of Medicine, Kyoto University, Japan.

Internal Medicine (Tokyo, Japan)
|April 29, 2025
PubMed

Insights

This case report describes hypertrophic pachymeningitis (HP) in a relapsing polychondritis (RP) patient with a Klebsiella pneumoniae infection. Prompt diagnosis and treatment led to symptom resolution, emphasizing infection

Area of Science:

  • Neurology
  • Rheumatology
  • Infectious Diseases

Background:

  • Relapsing polychondritis (RP) is a rare autoimmune disorder.
  • Central nervous system involvement in RP is uncommon but possible.
  • Hypertrophic pachymeningitis (HP) is a rare manifestation.

Purpose of the Study:

  • To report the first case of HP in an RP patient with a concurrent Klebsiella pneumoniae infection.
  • To highlight the diagnostic and therapeutic considerations for this rare presentation.

Main Methods:

  • Case presentation of a 48-year-old male with neurological symptoms.
  • Brain MRI to evaluate pachymeningitis.
  • Dural biopsy for microbial identification.
  • Auricular cartilage biopsy for RP diagnosis.
  • Treatment with corticosteroids and infliximab.

Main Results:

  • The patient presented with transient neurological deficits.
  • Brain MRI revealed diffuse pachymeningitis.
  • Klebsiella pneumoniae was identified from a dural biopsy.
  • RP was confirmed via auricular cartilage biopsy.
  • Symptoms resolved following treatment.

Conclusions:

  • This case underscores the importance of considering bacterial infections in patients with RP and HP.
  • Concurrent Klebsiella pneumoniae infection can mimic or exacerbate HP in RP.
  • Integrated management of autoimmune disease and infection is crucial for favorable outcomes.
Keywords:
Klebsiella pneumoniaepachymeningitisrelapsing polychondritis

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