Rheumatoid meningitis: a case series report and review of modern therapeutic schemes and outcome.

Autor: Serra Smith C; Neurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain. caserra@ucm.es., Montero Reyes FJ; Rheumatology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain., Contreras Chicote A; Neurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain., Martínez Barrio J; Rheumatology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain., Vieru M; Anatomical Pathology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain., Herrera Herrera I; Neurorradiology Section, Radiology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain., Arias F; Anatomical Pathology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain., Martínez Ginés M; Neurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain., García Domínguez JM; Neurology Department, Hospital General Universitario Gregorio Marañón, 46 Doctor Esquerdo Street, 28007, Madrid, Spain.
Jazyk: angličtina
Zdroj: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2024 Dec; Vol. 45 (12), pp. 5875-5887. Date of Electronic Publication: 2024 Jul 16.
DOI: 10.1007/s10072-024-07681-8
Abstrakt: Introduction: Rheumatoid meningitis (RM) is an extremely rare extra-articular complication of rheumatoid arthritis (RA), with approximately 165 cases reported world-wide. RM exhibits a broad range of symptoms, with stroke-like episodes and seizures being the most common manifestations. The primary differential diagnoses include vascular and infectious diseases. The influence of immunomodulatory medications on the pathophysiology of RM remains unclear. There are no consensus guidelines on therapeutic regimen.
Methods: We present four patients with prior history of RA that developed different neurological syndromes in correlation to radiological leptomeningitis. Clinical presentations, comorbid conditions, supplementary diagnostic assessments, treatments, and prognosis are provided. A literature review of recent immunosuppressive management in RM patients was performed.
Results: Three patients presented to hospital with recurrent focal seizures. Only two suffered meningism, reporting headache and fever. Magnetic resonance imaging (MRI) showed different grades of leptomeningitis across all cases. Notably, three cases demonstrated bilateral involvement extending to the pachymeninges. Two patients exhibited pronounced CSF mononuclear inflammation while extended microbiological evaluations yielded negative results. Two patients required biopsy for confirmation. The initiation of immunosuppressive therapy marked a turning point for three patients who previously exhibited progressive deterioration. Mortality was absent in all cases.
Conclusions: Our experience remarks the elusive nature of RM. Rigorous exclusionary diagnostics are imperative to differentiate RM from mimicking conditions. Clinical manifestations oscillate between transient episodes and progressive neurological impairments, punctuated by frequent epileptic seizures. In scenarios where clinical worsening persists or where clinical and radiological evaluations are inconclusive, aggressive immunosuppressive therapy is recommended.
Competing Interests: Declarations Conflict of interest None. Ethical statement No ethical conflicts have arisen during the course of this research. The authors declare that they have no competing interests, financial or otherwise, that could have influenced the outcomes of this study. Informed consent statement All four patients provided their informed consent for the disclosure of their cases for scientific and educational purposes.
(© 2024. Fondazione Società Italiana di Neurologia.)
Databáze: MEDLINE
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