类风湿性脑膜炎：利妥昔单抗治疗成功缓解
Rheumatoid meningitis: successful remission with rituximab.
作者信息
Harrison Nancy Salloum, Kishore Shweta, Majithia Vikas
机构信息
Department of Rheumatology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
出版信息
BMJ Case Rep. 2018 Dec 31;11(1):e226642. doi: 10.1136/bcr-2018-226642.
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.
一名53岁的类风湿性关节炎男性患者，在服用抗癫痫药物期间出现反复头痛、癫痫发作和右侧下肢瘫痪。检查发现脑部磁共振成像（MRI）显示硬脑膜和软脑膜强化。鉴别诊断包括多种感染、肿瘤和血管炎。组织病理学显示的结果与类风湿性脑膜炎（RM）一致。最终，根据症状、MRI表现和组织病理学，他被诊断为RM。开始静脉注射脉冲剂量类固醇，随后每6个月注射一次利妥昔单抗，脑部MRI表现有显著改善。患者一直未再发作癫痫。
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