The Successful Treatment of Myeloperoxidase Antineutrophil Cytoplasmic Antibody-positive Hypertrophic Pachymeningitis in Patients with the Limited Form of Granulomatosis with Polyangiitis Using Methotrexate: Two Case Reports

  • Kaieda Shinjiro
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan
  • Yoshida Naomi
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan
  • Minezaki Midori
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan
  • Ushijima Shuri
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan
  • Wakasugi Daisuke
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan
  • Miura Shiroh
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan
  • Uchiyama Yusuke
    Department of Radiology, Kurume University School of Medicine, Japan
  • Ida Hiroaki
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan
  • Hoshino Tomoaki
    Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan

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Abstract

<p>Recent findings have indicated a close relationship between myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-positive hypertrophic pachymeningitis and the limited form of granulomatosis with polyangiitis (GPA). In Japan, MPO-ANCA-positive hypertrophic pachymeningitis predominantly occurs in elderly individuals. We herein describe the cases of two patients with MPO-ANCA-positive hypertrophic pachymeningitis associated with the limited form of GPA who were successfully treated with a combination of corticosteroids and methotrexate. Although methotrexate has been shown to be less effective than cyclophosphamide for inducing the remission of GPA in patients with organ-threatening diseases, its safety and efficacy may make it a useful alternative treatment modality for patients with the limited form of GPA who show meningeal involvement. </p>

Journal

  • Internal Medicine

    Internal Medicine 56 (8), 959-965, 2017

    The Japanese Society of Internal Medicine

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