Presentation
Headache radiating to the neck, aggravated by bright light. Additional symptoms included low-grade fever in the evening and pain in the wrist joints. Neurological examination revealed mildly positive meningeal signs and brisk tendon reflexes.
Patient Data
MR images reveal prominent unilateral right-sided leptomeningeal contrast enhancement on T1 C+ sequences.
Case Discussion
The blood tests results:
red blood cells 4.07 x 1012/L ;
ESR 58 mm per hour ;
platelets 504 x 109/L ;
white blood cells 11.29 x 109/L ;
C-reactive protein 23.73 mg/L ;
anti-streptolysin O 265.00 IU/mL.
The patient's diagnosis is rheumatoid arthritis.
Unilateral involvement of leptomeninges and rheumatic disease lead to the diagnosis of rheumatoid meningitis. The patient refused a lumbar puncture. We treated her with 8 mg of methylprednisolone for two weeks. The patient described symptoms as fully resolved after the treatment.
The most likely diagnosis in this context is rheumatoid meningitis as a manifestation of rheumatoid arthritis.
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