Two cases of rheumatoid meningitis
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Auteurs : Shino Magaki [États-Unis] ; Edward Chang ; Robert R. Hammond ; Isaac Yang ; Ian R. A. Mackenzie [Canada] ; Benedict T. Chou ; Soo I. Choi ; Joanna C. Jen ; Whitney B. Pope ; David A. Bell [Canada] ; Harry V. Vinters [États-Unis]Source :
- Neuropathology [ 0919-6544 ] ; 2016-02.
Abstract
Central nervous system (CNS) involvement by rheumatoid arthritis (RA) in the form of rheumatoid meningitis (RM) is rare and most commonly occurs in the setting of longstanding severe RA. Due to a wide range of clinical presentations and nonspecific laboratory findings, it presents a diagnostic challenge often requiring brain biopsy. Only a few histopathologically confirmed cases have been described in the literature. Our aim is to describe two cases of RM and review the literature. The first case is of a previously healthy 37‐year‐old man who presented with severe headaches and focal neurologic deficits. Magnetic resonance imaging demonstrated abnormal leptomeningeal enhancement in the left frontal and parietal sulci. The second case is of a 62‐year‐old woman with a history of mild chronic joint pain who presented with confusion, personality changes and seizures. Both patients ultimately underwent brain biopsy which demonstrated RM on pathologic examination. Administration of corticosteroids resulted in significant clinical improvement in both cases. To our knowledge, our unusual case of RM in the young man is the fifth reported case of rheumatoid meningitis in a patient with no prior history of RA. Such an atypical presentation makes diagnosis even more difficult and highlights the need for awareness of this entity in the diagnostic consideration of a patient presenting with unexplained neurologic symptoms. Our literature review underscores the clinical and pathologic heterogeneity of CNS involvement in RA.
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DOI: 10.1111/neup.12238
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Edward Chang<affiliation><mods:affiliation>Department of Neurology</mods:affiliation><wicri:noCountry code="no comma">Department of Neurology</wicri:noCountry></affiliation><affiliation><mods:affiliation>Division of Neuropathology, Department of Pathology</mods:affiliation><wicri:noCountry code="subField">Pathology</wicri:noCountry></affiliation><affiliation><mods:affiliation>Department of Neurosurgery</mods:affiliation><wicri:noCountry code="no comma">Department of Neurosurgery</wicri:noCountry></affiliation><affiliation><mods:affiliation>Division of Rheumatology, Department of Medicine</mods:affiliation><wicri:noCountry code="subField">Medicine</wicri:noCountry></affiliation><affiliation><mods:affiliation>Division of Rheumatology, Department of Medicine</mods:affiliation><wicri:noCountry code="subField">Medicine</wicri:noCountry></affiliation><affiliation><mods:affiliation>Department of Neurology</mods:affiliation><wicri:noCountry code="no comma">Department of Neurology</wicri:noCountry></affiliation><affiliation><mods:affiliation>Department of Radiological Sciences</mods:affiliation><wicri:noCountry code="no comma">Department of Radiological Sciences</wicri:noCountry></affiliation>Le document en format XML
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Vinters</name><affiliation><mods:affiliation>Section of Neuropathology, Department of Pathology and Laboratory Medicine</mods:affiliation><wicri:noCountry code="subField">Medicine</wicri:noCountry></affiliation><affiliation><mods:affiliation>Department of Neurology</mods:affiliation><wicri:noCountry code="no comma">Department of Neurology</wicri:noCountry></affiliation><affiliation wicri:level="1"><mods:affiliation>Brain Research Institute, University of California, Los Angeles (UCLA) Medical Center and David Geffen School of Medicine, California, Los Angeles, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Brain Research Institute, University of California, Los Angeles (UCLA) Medical Center and David Geffen School of Medicine, California, Los Angeles</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:561DCABD7E3FA93A0C92F0AD6960DEF5B1A2604F</idno><date when="2016" year="2016">2016</date><idno type="doi">10.1111/neup.12238</idno><idno type="url">https://api.istex.fr/ark:/67375/WNG-FJPGJ6MH-9/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000D61</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000D61</idno><idno type="wicri:Area/Istex/Curation">000D61</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main">Two cases of rheumatoid meningitis</title><author><name sortKey="Magaki, Shino" sort="Magaki, Shino" uniqKey="Magaki S" first="Shino" last="Magaki">Shino Magaki</name><affiliation><mods:affiliation>Section of Neuropathology, Department of Pathology and Laboratory Medicine</mods:affiliation></affiliation><affiliation wicri:level="1"><mods:affiliation>E-mail: smagaki@mednet.ucla.edu</mods:affiliation><country wicri:rule="url">États-Unis</country></affiliation></author><author><name sortKey="Chang, Edward" sort="Chang, Edward" uniqKey="Chang E" first="Edward" last="Chang">Edward Chang</name><affiliation><mods:affiliation>Department of Neurology</mods:affiliation><wicri:noCountry code="no comma">Department of Neurology</wicri:noCountry></affiliation></author><author><name sortKey="Hammond, Robert R" sort="Hammond, Robert R" uniqKey="Hammond R" first="Robert R." last="Hammond">Robert R. Hammond</name><affiliation><mods:affiliation>Division of Neuropathology, Department of Pathology</mods:affiliation><wicri:noCountry code="subField">Pathology</wicri:noCountry></affiliation></author><author><name sortKey="Yang, Isaac" sort="Yang, Isaac" uniqKey="Yang I" first="Isaac" last="Yang">Isaac Yang</name><affiliation><mods:affiliation>Department of Neurosurgery</mods:affiliation><wicri:noCountry code="no comma">Department of Neurosurgery</wicri:noCountry></affiliation></author><author><name sortKey="Mackenzie, Ian R A" sort="Mackenzie, Ian R A" uniqKey="Mackenzie I" first="Ian R. A." last="Mackenzie">Ian R. A. Mackenzie</name><affiliation wicri:level="1"><mods:affiliation>Department of Pathology, University of British Columbia and Vancouver General Hospital, British Columbia, Vancouver, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Pathology, University of British Columbia and Vancouver General Hospital, British Columbia, Vancouver</wicri:regionArea></affiliation></author><author><name sortKey="Chou, Benedict T" sort="Chou, Benedict T" uniqKey="Chou B" first="Benedict T." last="Chou">Benedict T. Chou</name><affiliation><mods:affiliation>Division of Rheumatology, Department of Medicine</mods:affiliation><wicri:noCountry code="subField">Medicine</wicri:noCountry></affiliation></author><author><name sortKey="Choi, Soo I" sort="Choi, Soo I" uniqKey="Choi S" first="Soo I." last="Choi">Soo I. Choi</name><affiliation><mods:affiliation>Division of Rheumatology, Department of Medicine</mods:affiliation><wicri:noCountry code="subField">Medicine</wicri:noCountry></affiliation></author><author><name sortKey="Jen, Joanna C" sort="Jen, Joanna C" uniqKey="Jen J" first="Joanna C." last="Jen">Joanna C. Jen</name><affiliation><mods:affiliation>Department of Neurology</mods:affiliation><wicri:noCountry code="no comma">Department of Neurology</wicri:noCountry></affiliation></author><author><name sortKey="Pope, Whitney B" sort="Pope, Whitney B" uniqKey="Pope W" first="Whitney B." last="Pope">Whitney B. Pope</name><affiliation><mods:affiliation>Department of Radiological Sciences</mods:affiliation><wicri:noCountry code="no comma">Department of Radiological Sciences</wicri:noCountry></affiliation></author><author><name sortKey="Bell, David A" sort="Bell, David A" uniqKey="Bell D" first="David A." last="Bell">David A. Bell</name><affiliation wicri:level="1"><mods:affiliation>Department of Medicine, Western University, Ontario, London, Canada</mods:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Medicine, Western University, Ontario, London</wicri:regionArea></affiliation></author><author><name sortKey="Vinters, Harry V" sort="Vinters, Harry V" uniqKey="Vinters H" first="Harry V." last="Vinters">Harry V. Vinters</name><affiliation><mods:affiliation>Section of Neuropathology, Department of Pathology and Laboratory Medicine</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurology</mods:affiliation></affiliation><affiliation wicri:level="1"><mods:affiliation>Brain Research Institute, University of California, Los Angeles (UCLA) Medical Center and David Geffen School of Medicine, California, Los Angeles, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Brain Research Institute, University of California, Los Angeles (UCLA) Medical Center and David Geffen School of Medicine, California, Los Angeles</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Neuropathology</title><title level="j" type="alt">NEUROPATHOLOGY</title><idno type="ISSN">0919-6544</idno><idno type="eISSN">1440-1789</idno><imprint><biblScope unit="vol">36</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="93">93</biblScope><biblScope unit="page" to="102">102</biblScope><biblScope unit="page-count">10</biblScope><date type="published" when="2016-02">2016-02</date></imprint><idno type="ISSN">0919-6544</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0919-6544</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Central nervous system (CNS) involvement by rheumatoid arthritis (RA) in the form of rheumatoid meningitis (RM) is rare and most commonly occurs in the setting of longstanding severe RA. Due to a wide range of clinical presentations and nonspecific laboratory findings, it presents a diagnostic challenge often requiring brain biopsy. Only a few histopathologically confirmed cases have been described in the literature. Our aim is to describe two cases of RM and review the literature. The first case is of a previously healthy 37‐year‐old man who presented with severe headaches and focal neurologic deficits. Magnetic resonance imaging demonstrated abnormal leptomeningeal enhancement in the left frontal and parietal sulci. The second case is of a 62‐year‐old woman with a history of mild chronic joint pain who presented with confusion, personality changes and seizures. Both patients ultimately underwent brain biopsy which demonstrated RM on pathologic examination. Administration of corticosteroids resulted in significant clinical improvement in both cases. To our knowledge, our unusual case of RM in the young man is the fifth reported case of rheumatoid meningitis in a patient with no prior history of RA. Such an atypical presentation makes diagnosis even more difficult and highlights the need for awareness of this entity in the diagnostic consideration of a patient presenting with unexplained neurologic symptoms. Our literature review underscores the clinical and pathologic heterogeneity of CNS involvement in RA.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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