Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA) and has a high mortality rate. It can present as a first diagnosis of RA, in long-standing disease, or in active or well-controlled disease. Neurological manifestations vary widely.
A patient with a 30-year history of RA, well controlled with methotrexate therapy, presented with new-onset seizures. Magnetic resonance imaging showed leptomeningeal and pachymeningeal enhancement. A de novo workup resulted in diagnosis of RM.
Cerebrospinal fluid findings for RM are nonspecific, typically lymphocytic pleocytosis; however, they can be neutrophilic, as in this case. Magnetic resonance imaging findings consist of leptomeningeal and pachymeningeal enhancement but can also involve the parenchyma. The diagnosis is typically confirmed with meningeal biopsy. Treatment involves high-dose corticosteroids or immunomodulatory therapy, or both. Long-term follow-up with radiologic surveillance typically ranges from improvement to resolution.
*Department of Neurology
∥Division of Rheumatology, Mayo Clinic, Scottsdale
†Department of Radiology
‡Division of Otolaryngology Head and Neck Surgery
§Department of Neurosurgery, Mayo Clinic Hospital, Phoenix, AZ
A.M.P. and L.A.Z. contributed equally.
The authors declare no conflict of interest.
Reprints: Angela M. Parsons, DO, Department of Neurology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ 85259.E-mail: email@example.com.