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Steroid responsive chronic meningoencephalitis reminiscent of rheumatoid meningitis: a case report
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- Morimoto Satoru
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology
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- Takao Masaki
- Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology Department of Neurology and Stroke, Saitama Medical University International Medical Center
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- Sakurai Keita
- Department of Radiology, Nagoya City University
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- Sunagawa Masako
- Department of General Medicine, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology
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- Komiya Tadashi
- Department of Neurology, National Hospital Organization Tokyo National Hospital
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- Arai Tomio
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology
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- Kanemaru Kazutomi
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology
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- Murayama Shigeo
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institution of Gerontology
Bibliographic Information
- Other Title
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- ステロイド療法が著効した慢性髄膜炎の1例―リウマチ性髄膜炎との鑑別の観点から―
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Description
A 62-year-old woman presented at our hospital with a headache, cognitive decline, and fever that had persisted for 3 months. On admission, fever, headache, and mild cognitive dysfunction were all clearly evident, suggesting chronic meningoencephalitis. Laboratory examination showed mild neutrophilia as well as an increase in her erythrocyte sedimentation rate and serum C-reactive protein levels. MRI showed multiple small hyperintense lesions on T2 weighted image and diffusion weighted image (DWI) in the cerebral cortex and white matter. Contrast-enhanced T1 weighted image showed the abnormal pial enhancement along the cerebral sulci. Systemic evaluations for infectious organisms, autoantibodies, and malignant tumors were all negative. Her fever and neurological symptoms continued. As a result of worsening MRI findings, a brain biopsy was carried out. Neuropathological analysis revealed neutrophilic infiltration in the subarachnoid space and multinucleated giant cells. However, there was no vasculitis on the histological sections. This pathological finding was reminiscent of rheumatoid meningitis despite articular findings of rheumatoid arthritis, as well as rheumatoid factor (RF) and anti-CCP antibody tests being negative. After oral steroid therapy, her fever and inflammatory reactions by laboratory test diminished and her cognitive function improved remarkably.
Journal
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- Rinsho Shinkeigaku
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Rinsho Shinkeigaku 55 (8), 573-579, 2015
Societas Neurologica Japonica