Rheumatoid Meningitis Associated with Infliximab

Seago, Susan; Stroberg, Edana; Metting, Austin

doi:10.1080/08998280.2016.11929419

Cited by 10 publications

(11 citation statements)

References 8 publications

(5 reference statements)

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“…Similar to our findings, results from several case reports and cohort studies have described meningitis or meningoencephalitis in patients with autoimmune disease (rheumatoid arthritis, ankylosing spondylitis, psoriasis and psoriatic arthritis, Crohn disease) treated with a TNF inhibitor. [25][26][27][28][29][30][31][32][33] Tumor necrosis factor inhibitors are reported to have efficacy in treating pulmonary and CNS sarcoidosis as well as other inflammatory disorders such as Behçet disease. [34][35][36] We identified 8 patients with de novo neurosarcoidosis, of which 7 had previous TNF inhibitor exposure.…”

Section: Discussionmentioning

confidence: 99%

Association Between Tumor Necrosis Factor Inhibitor Exposure and Inflammatory Central Nervous System Events

et al. 2020

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Tumor necrosis factor (TNF) inhibitors are common therapies for certain autoimmune diseases, such as rheumatoid arthritis. An association between TNF inhibitor exposure and inflammatory central nervous system (CNS) events has been postulated but is poorly understood. OBJECTIVE To evaluate whether TNF inhibitor exposure is associated with inflammatory demyelinating and nondemyelinating CNS events in patients with an indication for TNF inhibitor use and to describe the spectrum of those CNS events. DESIGN, SETTING, AND PARTICIPANTS A nested case-control study was conducted using the medical records of patients with autoimmune diseases treated at 3 Mayo Clinic locations

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Section: Discussionmentioning

confidence: 99%

Association Between Tumor Necrosis Factor Inhibitor Exposure and Inflammatory Central Nervous System Events

et al. 2020

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“…Interestingly, anti-TNFα agents have been associated with the development of accelerated nodulosis (40) and two reports present cases of aseptic meningitis in the context of adalimumab (41) and etanercept (42) use. There are at least six cases of meningeal rheumatoid disease occurring in patients being treated with anti-TNFα agents reported in the literature that implicate infliximab (13, 15, 28), adalimumab (12, 23), and etanercept (32). It remains unclear whether this is confounded by disease severity or whether these agents were simply non-protective due to low blood-brain-barrier permeability (13).…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid Meningitis Presenting With Acute Parkinsonism and Protracted Non-convulsive Seizures: An Unusual Case Presentation and Review of Treatment Strategies

et al. 2019

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Rheumatoid meningitis is a rare complication of rheumatoid arthritis (RA). It is associated with substantial morbidity and mortality. The condition may present in a variety of ways and is therefore diagnostically challenging. Uncertainty still exists regarding the optimal treatment strategy. Herein, we describe the case of a 74-year-old man with a history of well-controlled seropositive RA on low-dose prednisone, hydroxychloroquine, and methotrexate. The patient presented with a several-month history of multiple prolonged episodes of expressive aphasia, right hemiparesis, and encephalopathy. Although no epileptiform activity was recorded on repeated electroencephalography, the symptoms fully resolved following treatment with antiepileptic drugs. He subsequently developed acute asymmetrical parkinsonism of the right hemibody. Magnetic resonance imaging revealed subtle enhancement of the leptomeninges over the left frontoparietal convexity. Cerebrospinal fluid analysis revealed a mild lymphocytic pleocytosis and elevated proteins. Histopathologic analysis of a meningeal biopsy revealed nodular rheumatoid meningitis. The patient was treated with corticosteroids and cyclophosphamide, following which he incompletely recovered. This is the first description of rheumatoid meningitis manifesting with acute parkinsonism and protracted non-convulsive seizures. A summary of cases reported since 2005, including data on pathology, therapy and outcomes, along with a discussion on the efficacy of different treatment strategies are provided.

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“…Two months prior to death, he developed focal onset seizures that were later explained by dural rheumatoid nodules at autopsy 2. In total, less than 60 biopsy proven cases of RM have been reported in the English literature 1 3–12. However, only six cases did not have a prior history of RA; all of these cases subsequently developed classical symptoms of RA within a few months to 1 year after initial presentation of RM 1 12–15…”

Section: Discussionmentioning

confidence: 99%

“…Pathophysiology remains unknown. There are five case reports of RM temporally linked to anti- tumour necrosis factor (TNF) inhibitor initiation 5 7. Anti-TNF inhibitors rarely result in the paradoxical development of rheumatoid nodules; some suggest that this may include meningeal rheumatoid nodules 5 7…”

Section: Discussionmentioning

confidence: 99%

Rheumatoid arthritis presenting as rheumatoid meningitis

et al. 2019

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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°C). 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 >340 AU/mL. Initial cerebrospinal fluid (CSF) was predominantly lymphocytic 96%, with elevated protein 672 mg/L and normal glucose 3.4 mmol/L. Interval CSF revealed newly low glucose 2.6 mmol/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.

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Rheumatoid Meningitis Associated with Infliximab

Cited by 10 publications

References 8 publications

Association Between Tumor Necrosis Factor Inhibitor Exposure and Inflammatory Central Nervous System Events

Association Between Tumor Necrosis Factor Inhibitor Exposure and Inflammatory Central Nervous System Events

Rheumatoid Meningitis Presenting With Acute Parkinsonism and Protracted Non-convulsive Seizures: An Unusual Case Presentation and Review of Treatment Strategies

Rheumatoid arthritis presenting as rheumatoid meningitis

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