title: A case of anti-cyclic citrullinated peptides antibody positive rheumatoid meningitis without arthritis at the onset of neurological symptoms.
abstract: We report an 84-year-old woman with rheumatoid meningitis. She developed weakness in her muscles and became cognitively impaired. However, physical examination revealed no evidence of rheumatoid arthritis. Levels of anti-cyclic citrullinated peptide antibodies were elevated. Brain magnetic resonance imaging (MRI) showed hyperintense lesions in the frontotemporoparietal subarachnoid space on fluid attenuated inversion recovery (FLAIR) images. Leptomeningeal enhancement was also evident on gadolinium-enhanced T1-weighted images. We suspected rheumatoid meningitis. A brain biopsy was performed and methylprednisolone pulse therapy was started. Subsequently, her symptoms and MRI findings rapidly improved.
authors: Department of Neurology, Saitama Medical University International Medical Center.
authors: Tetsuya
authors: T
authors: Abe
authors: Kazuhiko
authors: K
authors: Mishima
authors: Akira
authors: A
authors: Uchino
authors: Atsushi
authors: A
authors: Sasaki
authors: Norio
authors: N
authors: Tanahashi
authors: Masaki
authors: M
authors: Takao
mesh_terms: D017668:Age of Onset; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000276:immunology; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008581:Meningitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D008775:Methylprednisolone / Q000008:administration & dosage; D010456:Peptides, Cyclic / Q000276:immunology*; D020551:Pulse Therapy, Drug; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D008775:Methylprednisolone