Unilateral meningitis: unusual central nervous system involvement in rheumatoid arthritis

A 40-year-old woman developed acute onset of right-sided weakness with ipsilateral partial motor seizures. She had a 6-month history of well-controlled rheumatoid arthritis treated with certolizumab (a biological pegylated tumour necrosis factor (TNF)-α inhibitors). MR scan of brain showed diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity of the left fronto-parietal cortex without apparent diffusion coefficient (ADC) signal restriction and left-sided focal lepto-meningeal and pachy-meningeal enhancement, suggesting unilateral meningitis (figure 1A).

Cerebrospinal fluid (CSF) analysis was showed only a mild pleocytosis. Serum IgG4 and serum anti-myelin oligodendrocyte glycoprotein antibodies were normal. Following high-dose intravenous methylprednisolone, she promptly recovered within 2 weeks, and her MR brain scan returned to normal (figure 1B).

Rheumatoid aseptic meningitis is a rare manifestation of rheumatoid arthritis. It is independent of the duration and activity of the disease1 2 and has a high mortality rate. Anti-TNF therapies do not…

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