A case of rheumatoid meningitis with anti-cyclic citrullinated peptides antibody in cerebrospinal fluids accorded with the change of the clinical course

Abstract

We report a 77-year-old man with rheumatoid meningitis. He came to the hospital because he had difficulty in walking and communication. His brain magnetic resonance imaging（MRI）showed increased fluid attenuated inversion recovery（FLAIR）signals in his right cerebral hemisphere cortex, and contrasting effects along the cerebral sulcus and surface were detected. Although he presented no joint symptoms, he was diagnosed with rheumatoid meningitis based on the positivity of RF and anti-CCP antibody in his cerebrospinal fluid and seurm, and the pathology of cerebral biopsy. After the initiation of corticosteroid therapy, the titer of anti-CCP antibody in his cerebrospinal fluids were decreased in accordance with the change of the clinical course. Anti-CCP antibody in the cerebrospinal fluids was a helpful biomarker in diagnosis and assessment of the severity of rheumatoid meningitis.