title: Anti-Cyclic Citrullinated Peptide Antibody-Positive Meningoencephalitis in the Preclinical Period of Rheumatoid Arthritis.
abstract: Rheumatoid meningoencephalitis (RM) is a rare complication of rheumatoid arthritis (RA). This report describes a 63-year-old man with complaints of high-grade fever, headache, and vomiting for several days before admission. Both his serum and cerebrospinal fluid were positive for anti-cyclic citrullinated peptide (CCP) antibody and rheumatoid factor, and contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (MRI) showed abnormal gadolinium enhancement of the meninges and high-intensity lesions in the subarachnoid spaces. The patient was diagnosed with RM despite lack of signs suggesting RA. His symptoms drastically improved with intravenous infusion of high-dose methylprednisolone. Two months later, he developed RA. The findings in this patient suggest that RM could develop prior to the onset of RA. Anti-CCP antibody and MRI findings may be useful for the diagnosis of RM, regardless of RA history.
authors.affiliation: Division of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Shibahara
authors.affiliation: Division of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan.
authors.forename: Tomonaga
authors.initials: T
authors.lastname: Matsushita
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Matsuo
authors.affiliation: Division of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fukushima
authors.affiliation: Division of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Stroke Center, Saga Medical Centre Koseikan, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sugimori
authors.affiliation: Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kamouchi
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ago
keywords: Anti-cyclic citrullinated peptide antibody; Extra-articular manifestation; Rheumatoid arthritis; Rheumatoid meningoencephalitis