Rheumatoid leptomeningitis presenting with an acute neuropsychiatric disorder. Issue 1 (10th August 2018)

• Record Type: Journal Article
• Authors: Lubomski, Michal; Sy, Joanne; Buckland, Michael; Lee, Andie S; Richards, Bethan; Thompson, Elizabeth; Fulham, Michael; Breen, Nora; Morris, Kirsty; Halmagyi, G Michael
• Is Part Of: Practical neurology. Volume 19:Issue 1(2019)
• Page Start: 68
• Page End: 71
• Publication Date: 2018-08-10
• Subjects: rheumatoid meningitis -- leptomeningitis -- pachymeningits -- neuropsychiatric disturbance -- rheumatoid arthritis; Neurology -- Periodicals; 616.8005
• DOI: 10.1136/practneurol-2018-001978
• Languages: English
• ISSNs: 1474-7758

Abstract

Abstract : Leptomeningitis is a rare central nervous system manifestation of rheumatoid arthritis, generally in patients with established chronic rheumatoid disease. We report a 41-year-old man without previous rheumatoid arthritis or psychiatric disorder who presented with an acute neuropsychiatric disturbance and polyarthralgia. His MR scan of brain showed asymmetric bifrontal leptomeningitis, confirmed on (18F)-fluoro-D-glucose-positron emission tomography. Other investigations showed highly positive serum and cerebrospinal fluid anti-cyclic citrullinated peptide. A leptomeningeal biopsy showed necrotising leptomeningeal inflammation with ill-defined granulomas and lymphoplasmacytic infiltrate without organisms. Prolonged high-dose corticosteroids and then rituximab resulted in recovery. Chronic leptomeningitis can present with an acute neuropsychiatric disorder. We highlight that early rheumatoid disease can, rarely, cause a chronic leptomeningitis, reversible with immunotherapy.