Rheumatoid meningitis: successful remission with rituximab.
Nancy Salloum HarrisonShweta KishoreVikas MajithiaPublished in: BMJ case reports (2018)
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.
Keyphrases
- contrast enhanced
- magnetic resonance imaging
- rheumatoid arthritis
- cerebrospinal fluid
- diffusion weighted imaging
- resting state
- diffuse large b cell lymphoma
- disease activity
- white matter
- rheumatoid arthritis patients
- computed tomography
- case report
- hodgkin lymphoma
- functional connectivity
- high dose
- small cell lung cancer
- chronic lymphocytic leukemia
- cerebral ischemia
- multiple sclerosis
- low grade
- physical activity
- blood brain barrier
- ankylosing spondylitis
- interstitial lung disease
- ulcerative colitis
- idiopathic pulmonary fibrosis