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Rheumatoid disease: an unusual cause of relapsing meningoencephalitis
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| Zeitschriftentitel: | BMJ Case Reports |
|---|---|
| Personen und Körperschaften: | , , , |
| In: | BMJ Case Reports, 2018, S. bcr-2017-222587 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
BMJ
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| Schlagwörter: |
| author_facet |
Alexander, Sian K Di Cicco, Maria Pohl, Ute Cifelli, Alberto Alexander, Sian K Di Cicco, Maria Pohl, Ute Cifelli, Alberto |
|---|---|
| author |
Alexander, Sian K Di Cicco, Maria Pohl, Ute Cifelli, Alberto |
| spellingShingle |
Alexander, Sian K Di Cicco, Maria Pohl, Ute Cifelli, Alberto BMJ Case Reports Rheumatoid disease: an unusual cause of relapsing meningoencephalitis General Medicine |
| author_sort |
alexander, sian k |
| spelling |
Alexander, Sian K Di Cicco, Maria Pohl, Ute Cifelli, Alberto 1757-790X BMJ General Medicine http://dx.doi.org/10.1136/bcr-2017-222587 <jats:p>A 73-year-old man presented with three episodes of dysphasia and disinhibited behaviour, a single seizure and transient ischaemic attack-like events characterised by right arm and/or leg weakness. These episodes were separated by month-long asymptomatic intervals. Medical history included rheumatoid arthritis, which was clinically quiescent on leflunomide.</jats:p><jats:p>Repeated cerebrospinal fluid examination showed a persistent lymphocytosis with mildly reduced glucose and elevated protein; oligoclonal bands and viral PCR were negative. MRI of the brain was initially normal, but 7 months after initial presentation revealed meningeal enhancement with bifrontal cortical hyperintensities on T2/fluid-attenuated inversion recovery. Brain biopsy demonstrated necrotising granulomatous meningitis with mixed T cell and B cell infiltrates and without evidence of vasculitis or infection. Serum anticyclic citrullinated peptide antibodies were strongly positive.</jats:p><jats:p>The diagnosis of rheumatoid meningoencephalitis was made on the basis of brain biopsy findings and serological evidence of active rheumatoid disease. Steroids and rituximab therapy were started leading to clinical stabilisation.</jats:p> Rheumatoid disease: an unusual cause of relapsing meningoencephalitis BMJ Case Reports |
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| title |
Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_unstemmed |
Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_full |
Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_fullStr |
Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
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Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_short |
Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_sort |
rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
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General Medicine |
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http://dx.doi.org/10.1136/bcr-2017-222587 |
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2018 |
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<jats:p>A 73-year-old man presented with three episodes of dysphasia and disinhibited behaviour, a single seizure and transient ischaemic attack-like events characterised by right arm and/or leg weakness. These episodes were separated by month-long asymptomatic intervals. Medical history included rheumatoid arthritis, which was clinically quiescent on leflunomide.</jats:p><jats:p>Repeated cerebrospinal fluid examination showed a persistent lymphocytosis with mildly reduced glucose and elevated protein; oligoclonal bands and viral PCR were negative. MRI of the brain was initially normal, but 7 months after initial presentation revealed meningeal enhancement with bifrontal cortical hyperintensities on T2/fluid-attenuated inversion recovery. Brain biopsy demonstrated necrotising granulomatous meningitis with mixed T cell and B cell infiltrates and without evidence of vasculitis or infection. Serum anticyclic citrullinated peptide antibodies were strongly positive.</jats:p><jats:p>The diagnosis of rheumatoid meningoencephalitis was made on the basis of brain biopsy findings and serological evidence of active rheumatoid disease. Steroids and rituximab therapy were started leading to clinical stabilisation.</jats:p> |
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| author_facet | Alexander, Sian K, Di Cicco, Maria, Pohl, Ute, Cifelli, Alberto, Alexander, Sian K, Di Cicco, Maria, Pohl, Ute, Cifelli, Alberto |
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| description | <jats:p>A 73-year-old man presented with three episodes of dysphasia and disinhibited behaviour, a single seizure and transient ischaemic attack-like events characterised by right arm and/or leg weakness. These episodes were separated by month-long asymptomatic intervals. Medical history included rheumatoid arthritis, which was clinically quiescent on leflunomide.</jats:p><jats:p>Repeated cerebrospinal fluid examination showed a persistent lymphocytosis with mildly reduced glucose and elevated protein; oligoclonal bands and viral PCR were negative. MRI of the brain was initially normal, but 7 months after initial presentation revealed meningeal enhancement with bifrontal cortical hyperintensities on T2/fluid-attenuated inversion recovery. Brain biopsy demonstrated necrotising granulomatous meningitis with mixed T cell and B cell infiltrates and without evidence of vasculitis or infection. Serum anticyclic citrullinated peptide antibodies were strongly positive.</jats:p><jats:p>The diagnosis of rheumatoid meningoencephalitis was made on the basis of brain biopsy findings and serological evidence of active rheumatoid disease. Steroids and rituximab therapy were started leading to clinical stabilisation.</jats:p> |
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| spelling | Alexander, Sian K Di Cicco, Maria Pohl, Ute Cifelli, Alberto 1757-790X BMJ General Medicine http://dx.doi.org/10.1136/bcr-2017-222587 <jats:p>A 73-year-old man presented with three episodes of dysphasia and disinhibited behaviour, a single seizure and transient ischaemic attack-like events characterised by right arm and/or leg weakness. These episodes were separated by month-long asymptomatic intervals. Medical history included rheumatoid arthritis, which was clinically quiescent on leflunomide.</jats:p><jats:p>Repeated cerebrospinal fluid examination showed a persistent lymphocytosis with mildly reduced glucose and elevated protein; oligoclonal bands and viral PCR were negative. MRI of the brain was initially normal, but 7 months after initial presentation revealed meningeal enhancement with bifrontal cortical hyperintensities on T2/fluid-attenuated inversion recovery. Brain biopsy demonstrated necrotising granulomatous meningitis with mixed T cell and B cell infiltrates and without evidence of vasculitis or infection. Serum anticyclic citrullinated peptide antibodies were strongly positive.</jats:p><jats:p>The diagnosis of rheumatoid meningoencephalitis was made on the basis of brain biopsy findings and serological evidence of active rheumatoid disease. Steroids and rituximab therapy were started leading to clinical stabilisation.</jats:p> Rheumatoid disease: an unusual cause of relapsing meningoencephalitis BMJ Case Reports |
| spellingShingle | Alexander, Sian K, Di Cicco, Maria, Pohl, Ute, Cifelli, Alberto, BMJ Case Reports, Rheumatoid disease: an unusual cause of relapsing meningoencephalitis, General Medicine |
| title | Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_full | Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_fullStr | Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_full_unstemmed | Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_short | Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_sort | rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| title_unstemmed | Rheumatoid disease: an unusual cause of relapsing meningoencephalitis |
| topic | General Medicine |
| url | http://dx.doi.org/10.1136/bcr-2017-222587 |