Dehghan Ali, Meybodi Mahya Sadat Emami, Fooladmotlagh Shokoofeh, Zaremehrjardi Mohsen, Soltani Hamidreza
Division of Rheumatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Department of Internal Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Case Rep Rheumatol. 2024 Oct 17;2024:9699571. doi: 10.1155/2024/9699571. eCollection 2024.
This case represents the first diagnosis of pachymeningitis due to granulomatosis with polyangiitis (GPA) in an elderly Iranian man who initially presented with persistent daily headaches. PCR tests of cerebrospinal fluid for tuberculosis, brucellosis, and fungal infections all yielded negative results. Given the pachymeningitis pattern observed on brain MRI and the absence of infectious and lymphoma diseases, along with positive anti-PR3 and proteinuria (793 mg in a 24-h urine sample), a diagnosis of GPA was established. The patient was treated with five doses of pulse methylprednisolone and one dose of pulse cyclophosphamide (1 g). Additionally, prednisolone 60 mg daily, monthly pulse cyclophosphamide, a daily calcium-D tablet, and alendronate 70 mg weekly were prescribed. Subsequently, the patient's headaches, hearing loss, and vision loss were completely resolved. GPA should be considered in older individuals with persistent daily headaches, especially when pachymeningitis is evident. The use of contrast-enhanced brain MRI is an essential diagnostic tool in such cases.
该病例是一名伊朗老年男性因肉芽肿性多血管炎（GPA）导致硬脑膜炎的首例诊断，该患者最初表现为持续性每日头痛。脑脊液针对结核、布鲁氏菌病和真菌感染的PCR检测结果均为阴性。鉴于脑部MRI显示硬脑膜炎模式，且排除感染性疾病和淋巴瘤，同时抗PR3阳性及蛋白尿（24小时尿样中为793毫克），确诊为GPA。患者接受了五剂脉冲甲基强的松龙和一剂脉冲环磷酰胺（1克）治疗。此外，还开了每日60毫克强的松龙、每月脉冲环磷酰胺、每日一片钙D片和每周70毫克阿仑膦酸钠的处方。随后，患者的头痛、听力丧失和视力丧失完全缓解。对于有持续性每日头痛的老年人，尤其是硬脑膜炎明显时，应考虑GPA。在此类病例中，使用增强脑部MRI是重要的诊断工具。
