A Case of Rheumatoid Meningitis Diagnosed with FLAIR Images and Anti-cyclic Citrullinated Peptide Antibodies Levels

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  • SUZUKI Taro
    Department of Neurosurgery, Iwate Prefectural Ofunato Hospital
  • AKAMATSU Yosuke
    Department of Neurosurgery, Iwate Medical University
  • OSHIDA Sotaro
    Department of Neurosurgery, Iwate Prefectural Ofunato Hospital
  • SATO Shinpei
    Department of Neurosurgery, Iwate Prefectural Ofunato Hospital

抄録

<p>Rheumatoid meningitis (RM) is a rare but serious extra-articular manifestation of rheumatoid arthritis. Due to the absence of specific biomarkers, imaging findings, or guidelines for its detection, the diagnosis of RM is difficult. This report describes a patient of RM diagnosed with an open biopsy and discusses the utility of anticyclic citrullinated peptide antibodies (ACPA) levels in the serum and cerebrospinal fluid (CSF), and contrast-enhanced (CE) fluid-attenuated inversion recovery (FLAIR) images for screening and monitoring RM. A 65-year-old woman presented with a 2-month history of headaches. Imaging studies showed asymmetric meningeal and leptomeningeal involvement seen on brain magnetic resonance imaging (MRI). An open biopsy of the meninges and leptomeninges depicted palisaded and necrotizing granulomatous inflammation, which suggests rheumatoid nodules. Treatment with prednisolone and tocilizumab led to symptom improvement and reduced lesion intensity on follow-up MRI. Throughout the treatment, the ACPA index in her serum and CSF, and the findings of CE-FLAIR images, rather than the CE T1WI, reflected disease activity. For 6 months, the patient has been stable without symptom recurrence. The ACPA index and the CE-FLAIR images were useful for the diagnosis and monitoring of RM. To validate these findings, further studies are necessary.</p>

収録刊行物

  • NMC Case Report Journal

    NMC Case Report Journal 11 (0), 119-123, 2024-12-31

    一般社団法人 日本脳神経外科学会

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