Rheumatoid meningitis. A case report and review of the literature

Area of Science:

• Neurology
• Rheumatology
• Pathology

Background:

• Rheumatoid disease is a systemic autoimmune disorder primarily affecting joints.
• Meningeal involvement in rheumatoid disease is rare but can occur.
• Previous literature has not emphasized asymptomatic presentations of rheumatoid meningitis.

Observation:

• An 89-year-old male patient presented with focal rheumatoid inflammation of the dura and leptomeninges.
• The patient was neurologically asymptomatic.
• The patient had clinically inactive rheumatoid disease at the time of diagnosis.

Findings:

• Rheumatoid meningitis can be virtually asymptomatic, even with quiescent rheumatoid joint disease.
• The presence of vasculitis in meningeal or cerebral vessels correlates with symptomatic presentation.
• Intracranial rheumatoid lesions were found concurrently with rheumatoid lesions in other organs, notably the heart and lungs.

Implications:

• Highlights the importance of considering rheumatoid meningitis in patients with rheumatoid disease, even in the absence of neurological symptoms.
• Suggests that routine screening for intracranial involvement may be warranted in select rheumatoid disease patients.
• Underscores the systemic nature of rheumatoid disease, affecting multiple organs including the central nervous system.