Diffuse chronic leptomeningitis with seropositive rheumatoid arthritis: report of a case successfully treated as rheumatoid leptomeningitis

• Published in: Modern rheumatology Vol. 19; no. 5; pp. 556 - 562
• Main Authors: Shimada, Kota, Matsui, Toshihiro, Kawakami, Misato, Hayakawa, Hiromi, Futami, Hidekazu, Michishita, Kazuya, Takaoka, Hirokazu, Ikenaka, Tatsuoh, Komiya, Akiko, Nakayama, Hisanori, Hagiwara, Futoshi, Sugii, Shoji, Furukawa, Hiroshi, Ozawa, Yoshinori, Tohma, Shigeto
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01-10-2009; Informa Healthcare
• Subjects: Anti-Inflammatory Agents - therapeutic use; Arthritis, Rheumatoid - blood; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - pathology; Brain - pathology; Case Report; Case studies; Chronic Disease - drug therapy; Cytokines - blood; Disease Progression; Drug Administration Schedule; Drug therapy; Female; Ferritins - blood; Humans; Magnetic Resonance Imaging; Medical diagnosis; Medicine; Medicine & Public Health; Meningitis; Meningitis - blood; Meningitis - complications; Meningitis - drug therapy; Meningitis - pathology; Methylprednisolone - therapeutic use; Middle Aged; NMR; Nuclear magnetic resonance; Orthopedics; Pia Mater - pathology; Prednisolone - therapeutic use; Receptors, Interleukin-2 - blood; Rheumatoid arthritis; Rheumatology; Treatment Outcome; Rheumatoid meningitis; Chronic meningitis; Depression; MRI; Rheumatoid arthritis
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1007/s10165-009-0186-9

A case of biopsy-confirmed chronic leptomeningitis complicating rheumatoid arthritis in a 53-year old female is reported. Her symptoms included weight loss, severe depression, and pyrexia. Magnetic resonance imaging was useful in diagnosis. Intravenous methylprednisolone was prescribed (1 g/day for 3 days), followed by prednisolone (initial dose of 30 mg daily), and this treatment was effective. Her IgG-index, serum levels of soluble interleukin-2 receptor and ferritin, and cerebrospinal level of interleukin-6 paralleled her clinical course.