Rheumatoid cranial pachymeningitis successfully treated with long-term corticosteroid.
We report a 68-year-old man without clinical history of rheumatoid arthritis who presented with acute bilateral palsy of the IX and X cranial nerves secondary to pachymeningitis confirmed on cranial MRI. Rheumatoid factor in both serum and cerebrospinal fluid and anti-agalactosyl IgG antibody in serum were positive. The radiographs of hands and feet revealed signs of early rheumatism. The dural biopsy specimen showed chronic inflammation with infiltration of lymphocytes and histiocytes. A diagnosis of rheumatoid cranial pachymeningitis was made. Treatment with long-term corticosteroid was excellently effective.
Ii
Yuichiro
Y
Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan. ii-y@clin.medic.mie-u.ac.jp
Kuzuhara
Shigeki
S
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications* / Q000276:immunology; D001706:Biopsy; D003391:Cranial Nerves / Q000000981:diagnostic imaging / Q000473:pathology*; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D005528:Foot / Q000000981:diagnostic imaging; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D007074:Immunoglobulin G; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000188:drug therapy*; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood / Q000134:cerebrospinal fluid; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000888:Antibodies, Anti-Idiotypic; D007074:Immunoglobulin G; D012217:Rheumatoid Factor