{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:46:11Z","timestamp":1761709571651,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,12,12]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA). A 59-year-old man presented with a 10-day history of right-sided frontal headache and a 7-day history of subacute left-sided weakness. He had no history of RA. He was febrile (38.2\u00b0C). Left ankle dorsiflexion and plantarflexion were graded at 4+\/5. He developed focal onset motor seizures. He was intermittently febrile with minimal improvement despite intravenous antivirals and antimicrobials. Serology revealed elevated rheumatoid factor 88.2 IU\/mL and anti-cyclic citrullinated peptide (anti-CCP) IgG &gt;340\u2009AU\/mL. Initial cerebrospinal fluid (CSF) was predominantly lymphocytic 96%, with elevated protein 672\u2009mg\/L and normal glucose 3.4\u2009mmol\/L. Interval CSF revealed newly low glucose 2.6\u2009mmol\/L. Extensive CSF microbiology tests were negative. CSF cytology confirmed reactive lymphocytes. MRI brain revealed right frontoparietal leptomeningeal enhancement. Brain and leptomeningeal biopsy demonstrated florid leptomeningeal mixed inflammatory infiltrate without granulomas. The combination of elevated anti-CCP IgG, erosive arthropathy, CSF lymphocytosis, asymmetrical leptomeningeal enhancement and biopsy findings confirmed RM.<\/jats:p>","DOI":"10.1136\/bcr-2018-226649","type":"journal-article","created":{"date-parts":[[2019,1,11]],"date-time":"2019-01-11T04:30:18Z","timestamp":1547181018000},"page":"bcr-2018-226649","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Rheumatoid arthritis presenting as rheumatoid meningitis"],"prefix":"10.1136","volume":"12","author":[{"given":"Mary Clare","family":"McKenna","sequence":"first","affiliation":[{"name":"Department of Neurology, Cork University Hospital, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cork University Hospital, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niamh","family":"Bermingham","sequence":"additional","affiliation":[{"name":"Department of Neuropathology, Cork University Hospital, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Cronin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cork University Hospital, Cork, Ireland"},{"name":"Department of Clinical Neuroscience, College of Medicine and Health, University College Cork, Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,10]]},"reference":[{"key":"2025082702180148000_12.1.bcr-2018-226649.1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/neup.12238","article-title":"Two cases of rheumatoid meningitis","volume":"36","author":"Magaki","year":"2016","journal-title":"Neuropathology"},{"key":"2025082702180148000_12.1.bcr-2018-226649.2","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.7.3.239"},{"key":"2025082702180148000_12.1.bcr-2018-226649.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/17843286.2017.1375193","article-title":"Rheumatoid granulomatous disease and pachymeningitis successfully treated with rituximab","volume":"73","author":"Moeyersoons","year":"2018","journal-title":"Acta Clin Belg"},{"key":"2025082702180148000_12.1.bcr-2018-226649.4","doi-asserted-by":"crossref","first-page":"e108","DOI":"10.1212\/WNL.0000000000003744","article-title":"Pearls & Oy-sters: Asymmetric meningeal involvement is a common feature of rheumatoid meningitis","volume":"88","author":"Choi","year":"2017","journal-title":"Neurology"},{"key":"2025082702180148000_12.1.bcr-2018-226649.5","first-page":"1","article-title":"Rheumatoid meningitis occurring during etanercept treatment","volume":"2017","author":"Tsuzaki","year":"2017","journal-title":"Case Rep Neurol Med"},{"key":"2025082702180148000_12.1.bcr-2018-226649.6","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2015-001306"},{"key":"2025082702180148000_12.1.bcr-2018-226649.7","first-page":"204","article-title":"Rheumatoid meningitis associated with infliximab","volume":"29","author":"Seago","year":"2016","journal-title":"Proc"},{"key":"2025082702180148000_12.1.bcr-2018-226649.8","first-page":"163","article-title":"Rheumatoid meningitis: Diagnostic and therapeutic observations","volume":"80","author":"Stretz","year":"2016","journal-title":"Conn Med"},{"key":"2025082702180148000_12.1.bcr-2018-226649.9","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1001\/jamaneurol.2015.1105","article-title":"Rheumatoid meningitis presenting with multiple strokelike episodes","volume":"72","author":"Roy","year":"2015","journal-title":"JAMA Neurol"},{"key":"2025082702180148000_12.1.bcr-2018-226649.10","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2014-208745"},{"key":"2025082702180148000_12.1.bcr-2018-226649.11","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1212\/WNL.0000000000001498","article-title":"Rheumatoid-associated meningitis and vasculopathy","volume":"84","author":"Yeaney","year":"2015","journal-title":"Neurology"},{"key":"2025082702180148000_12.1.bcr-2018-226649.12","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1007\/s10072-015-2075-7","article-title":"Redefining a diagnosis: from meningeal plasma cell granuloma to rheumatoid meningitis. Report of a patient follow-up","volume":"36","author":"Padjen","year":"2015","journal-title":"Neurol Sci"},{"key":"2025082702180148000_12.1.bcr-2018-226649.13","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.05.0859"},{"key":"2025082702180148000_12.1.bcr-2018-226649.14","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000257824.72457.91"},{"key":"2025082702180148000_12.1.bcr-2018-226649.15","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1007\/s10072-011-0727-9","article-title":"A case of rheumatoid meningitis: pathologic and magnetic resonance imaging findings","volume":"32","author":"Kim","year":"2011","journal-title":"Neurol Sci"},{"key":"2025082702180148000_12.1.bcr-2018-226649.16","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.neurad.2013.10.005","article-title":"MRI with DWI helps in depicting rheumatoid meningitis","volume":"41","author":"Roques","year":"2014","journal-title":"J Neuroradiol"},{"key":"2025082702180148000_12.1.bcr-2018-226649.17","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-003-0788-0"},{"key":"2025082702180148000_12.1.bcr-2018-226649.18","doi-asserted-by":"crossref","unstructured":"Matsuda S , Yoshida S , Takeuchi T , et al . 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