A 53-year-old male with rheumatoid arthritis presented with recurrent headaches, seizures and right-sided lower extremity paralysis while on antiepileptic medications. Work up revealed pachymeningeal and leptomeningeal enhancement on brain MRI. Differential diagnosis included a variety of infections, neoplasm and vasculitis. Histopathology showed findings consistent with rheumatoid meningitis (RM). Ultimately based on symptoms, MRI findings and tissue pathology, he was diagnosed with RM. Intravenous pulse dose steroids were initiated followed by rituximab every 6 months, resulting in significant improvement of the brain MRI findings. Patient has remained seizure free.
- epilepsy and seizures
- rheumatoid arthritis
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Contributors NSH: initial preparation of the entire manuscript and compilation of contributions from other authors and reviewed the requirements and guidelines for submission and designed the template accordingly. SK: contributed in establishing the diagnosis and management of the patient as a rheumatology consultant, extensive literature search of similar cases, obtaining consent from the patient, writing the case presentation, revision of the manuscript, citation management, editing of images. VM:served as the chief of the division and supervised all the authors, set up timeline for submission, planning the submission to BMJ, reviewed the requirements, critical revision of the article at every stage, drafted the take-home messages, gave final approval of the version to be submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.