Rheumatoid meningitis: report of two cases

ABSTRACT Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA). RM mimics many other conditions such as subdural empyema, unsteady gait, focal brain dysfunction, stroke, relapsing-remitting motor signs, headache, neuropsychiatric disorders, seizures, parkinsonism, and mening...

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Autores principales:	Guevara,Carlos, Villa,Eduardo, Núñez,René, Grazia,José De
Lenguaje:	English
Publicado:	Sociedad Médica de Santiago 2021
Materias:	Arthritis, Rheumatoid Therapeutics Meningitis, Aseptic
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000200295
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spelling	oai:scielo:S0034-988720210002002952021-06-25Rheumatoid meningitis: report of two casesGuevara,CarlosVilla,EduardoNúñez,RenéGrazia,José De Arthritis, Rheumatoid Therapeutics Meningitis, Aseptic ABSTRACT Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA). RM mimics many other conditions such as subdural empyema, unsteady gait, focal brain dysfunction, stroke, relapsing-remitting motor signs, headache, neuropsychiatric disorders, seizures, parkinsonism, and meningeal tumors. RM is considered a disease with poor prognosis. However, cases reported in the last decade show a good outcome. We report two cases with a favorable outcome. A 48-year-old man with a three-year history of RA admitted for headache, sensory disturbances, and speech difficulties. Brain magnetic resonance imaging (MRI) showed a left parietal subdural laminar lesion with restricted diffusion and a small left superior frontal acute infarction. A subdural empyema was originally suspected, and antimicrobials were prescribed. A follow-up MRI did not show progression of the subdural lesion and the patient was discharged 14 days after admission without focal deficits. A 44-year-old female patient with two years of seronegative RA was admitted for severe headache, confusion, nausea and vomiting. Brain MRI showed subtle supra and infratentorial leptomeningeal involvement and a left cerebellar acute infarct. A meningoencephalitis due to etanercept was initially thought and treated with dexamethasone. The patient was discharged but had to be admitted again and a new MRI showed a progression of the leptomeningeal involvement. She worsened and required endotracheal intubation. Cyclophosphamide was started and the patient became asymptomatic three months later. We propose that treatment should not be delayed waiting a biopsy when a diagnosis of RM is made and after a cerebrospinal fluid infection has been ruled out.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.149 n.2 20212021-02-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000200295en10.4067/s0034-98872021000200295
institution	Scielo Chile
collection	Scielo Chile
language	English
topic	Arthritis, Rheumatoid Therapeutics Meningitis, Aseptic
spellingShingle	Arthritis, Rheumatoid Therapeutics Meningitis, Aseptic Guevara,Carlos Villa,Eduardo Núñez,René Grazia,José De Rheumatoid meningitis: report of two cases
description	ABSTRACT Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA). RM mimics many other conditions such as subdural empyema, unsteady gait, focal brain dysfunction, stroke, relapsing-remitting motor signs, headache, neuropsychiatric disorders, seizures, parkinsonism, and meningeal tumors. RM is considered a disease with poor prognosis. However, cases reported in the last decade show a good outcome. We report two cases with a favorable outcome. A 48-year-old man with a three-year history of RA admitted for headache, sensory disturbances, and speech difficulties. Brain magnetic resonance imaging (MRI) showed a left parietal subdural laminar lesion with restricted diffusion and a small left superior frontal acute infarction. A subdural empyema was originally suspected, and antimicrobials were prescribed. A follow-up MRI did not show progression of the subdural lesion and the patient was discharged 14 days after admission without focal deficits. A 44-year-old female patient with two years of seronegative RA was admitted for severe headache, confusion, nausea and vomiting. Brain MRI showed subtle supra and infratentorial leptomeningeal involvement and a left cerebellar acute infarct. A meningoencephalitis due to etanercept was initially thought and treated with dexamethasone. The patient was discharged but had to be admitted again and a new MRI showed a progression of the leptomeningeal involvement. She worsened and required endotracheal intubation. Cyclophosphamide was started and the patient became asymptomatic three months later. We propose that treatment should not be delayed waiting a biopsy when a diagnosis of RM is made and after a cerebrospinal fluid infection has been ruled out.
author	Guevara,Carlos Villa,Eduardo Núñez,René Grazia,José De
author_facet	Guevara,Carlos Villa,Eduardo Núñez,René Grazia,José De
author_sort	Guevara,Carlos
title	Rheumatoid meningitis: report of two cases
title_short	Rheumatoid meningitis: report of two cases
title_full	Rheumatoid meningitis: report of two cases
title_fullStr	Rheumatoid meningitis: report of two cases
title_full_unstemmed	Rheumatoid meningitis: report of two cases
title_sort	rheumatoid meningitis: report of two cases
publisher	Sociedad Médica de Santiago
publishDate	2021
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000200295
work_keys_str_mv	AT guevaracarlos rheumatoidmeningitisreportoftwocases AT villaeduardo rheumatoidmeningitisreportoftwocases AT nunezrene rheumatoidmeningitisreportoftwocases AT graziajosede rheumatoidmeningitisreportoftwocases
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Rheumatoid meningitis: report of two cases

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