Open AccessRheumatoid meningitis: successful remission with rituximab
Author(s) -
Nancy Salloum Harrison,
Shweta Kishore,
Vikas Majithia
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-226642
Subject(s) - medicine , rheumatoid arthritis , rituximab , headaches , meningitis , vasculitis , differential diagnosis , rheumatology , histopathology , surgery , radiology , pediatrics , pathology , disease , lymphoma
A 53-year-old male with rheumatoid arthritis presented with recurrent headaches, seizures and right-sided lower extremity paralysis while on antiepileptic medications. Work up revealed pachymeningeal and leptomeningeal enhancement on brain MRI. Differential diagnosis included a variety of infections, neoplasm and vasculitis. Histopathology showed findings consistent with rheumatoid meningitis (RM). Ultimately based on symptoms, MRI findings and tissue pathology, he was diagnosed with RM. Intravenous pulse dose steroids were initiated followed by rituximab every 6 months, resulting in significant improvement of the brain MRI findings. Patient has remained seizure free.