[A case of anti-cyclic citrullinated peptides antibody positive rheumatoid meningitis without arthritis at the onset of neurological symptoms]

Rinsho Shinkeigaku. 2016 Sep 29;56(9):627-32. doi: 10.5692/clinicalneurol.cn-000915. Epub 2016 Aug 31.
[Article in Japanese]

Abstract

We report an 84-year-old woman with rheumatoid meningitis. She developed weakness in her muscles and became cognitively impaired. However, physical examination revealed no evidence of rheumatoid arthritis. Levels of anti-cyclic citrullinated peptide antibodies were elevated. Brain magnetic resonance imaging (MRI) showed hyperintense lesions in the frontotemporoparietal subarachnoid space on fluid attenuated inversion recovery (FLAIR) images. Leptomeningeal enhancement was also evident on gadolinium-enhanced T1-weighted images. We suspected rheumatoid meningitis. A brain biopsy was performed and methylprednisolone pulse therapy was started. Subsequently, her symptoms and MRI findings rapidly improved.

Publication types

  • Case Reports

MeSH terms

  • Age of Onset
  • Aged, 80 and over
  • Arthritis, Rheumatoid / immunology
  • Autoantibodies / blood*
  • Biomarkers / blood
  • Brain / diagnostic imaging
  • Brain / pathology
  • Female
  • Humans
  • Magnetic Resonance Angiography
  • Meningitis / diagnosis*
  • Meningitis / drug therapy
  • Meningitis / etiology*
  • Methylprednisolone / administration & dosage
  • Peptides, Cyclic / immunology*
  • Pulse Therapy, Drug
  • Treatment Outcome

Substances

  • Autoantibodies
  • Biomarkers
  • Peptides, Cyclic
  • cyclic citrullinated peptide
  • Methylprednisolone