A case of rheumatoid meningitis: pathologic and magnetic resonance imaging findings
A case of rheumatoid meningitis: pathologic and magnetic resonance imaging findings
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DOI：
10.1007/s10072-011-0727-9
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发表时间：
2011-12-01
影响因子：
3.3
通讯作者：
Kim, Man Ho
中科院分区：
文献类型：
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作者：
Kim, Hye Yun;Park, Jong Ho;Kim, Man Ho
中枢神经系统（CNS）受累在类风湿性关节炎（RA）患者中极为罕见。此外，大多数累及CNS的患者患有慢性和重度RA。我们报告一位66岁男性，被诊断为类风湿性脑膜炎和中枢神经系统血管炎，没有类风湿关节炎病史。他最初的症状是癫痫。脑磁共振成像显示软脑膜增强。脑脊液分析显示白色血细胞数量轻微增加。病毒标志物检查和感染性病原学培养研究均无异常。然而，类风湿因子阳性，抗环瓜氨酸肽抗体水平很高。患者被诊断为类风湿性脑膜炎并接受类固醇治疗。然而，他发生了CNS血管炎。我们建议，在未控制脑膜炎患者的鉴别诊断阶段，应考虑类风湿性脑膜炎的可能性，即使RA通常不显示CNS受累。
Central nervous system (CNS) involvement is extremely rare in patients with rheumatoid arthritis (RA). Additionally, most patients with CNS involvement have chronic and severe RA. We present a report of a 66-year-old man who was diagnosed with rheumatoid meningitis and CNS vasculitis without a history of RA. His initial symptom was seizure. Brain magnetic resonance imaging showed leptomeningeal enhancement.CSF analysis revealed slight increase in the number of white blood cells. An examination of viral markers and culture studies for infectious etiology were unremarkable. However, the rheumatoid factor was positive and the levels of anti-cyclic citrullinated peptide antibody were very high. The patient was diagnosed with rheumatoid meningitis and received steroid therapy. However, he developed CNS vasculitis. We suggested that the possibility of rheumatoid meningitis should be considered during the differential diagnosis stage in patients with uncontrolled meningitis, even though RA does not typically show CNS involvement.