Beyond the Joints: Rheumatoid Leptomeningitis as a Rare Cause of Progressive Neurologic Symptoms
Mamadou Diallo1, Sindu Mukesh2, Ruba Shaik3, Ribal Haddad4
1Neurology, Carle Foundation Hospital, Carle Illinois College of Medicine, 2Cleveland Clinic Florida, 3Carle Illinois College of Medicine, 4Carle Health
Objective:
To describe a rare case of rheumatoid leptomeningitis (RLM) and emphasize the diagnostic and therapeutic challenges of this uncommon central nervous system manifestation of rheumatoid arthritis (RA).
Background:
Rheumatoid arthritis is a chronic systemic autoimmune disease affecting approximately 0.5–1% of the population, frequently associated with extra‑articular involvement. Central nervous system manifestations are rare, with rheumatoid leptomeningitis representing an exceptionally uncommon and often underrecognized complication. RLM can occur in patients with long‑standing, well‑controlled, or minimally active RA and presents with highly variable, nonspecific neurologic symptoms including seizures, headache, encephalopathy, and focal deficits. Neuroimaging and cerebrospinal fluid (CSF) findings are often suggestive but nonspecific, complicating diagnosis. Due to its rarity, absence of standardized diagnostic criteria, and overlap with infectious, malignant, and other autoimmune etiologies, diagnosis is frequently delayed, and management relies largely on case‑based experience.
Design/Methods:
Case report
Results:
A 60‑year‑old woman with seropositive RA presented with progressive neurologic symptoms, including sensory disturbances, gait instability, headaches with photophobia, cognitive slowing, and urinary urgency. Brain MRI demonstrated diffuse leptomeningeal enhancement, while CSF analysis revealed lymphocytic pleocytosis, elevated protein, and increased IgG index with negative infectious and paraneoplastic studies. Despite partial response to corticosteroids, symptoms recurred, and repeat imaging showed persistent meningeal inflammation. Meningeal biopsy confirmed chronic leptomeningitis. She was treated with rituximab and corticosteroids, resulting in partial symptomatic improvement, though residual neurologic deficits persisted.
Conclusions:
This case highlights rheumatoid leptomeningitis as a rare but important neurologic complication of RA. Early recognition, exclusion of alternative etiologies, and prompt initiation of immunosuppressive therapy are critical to improving outcomes. Increased awareness and reporting are essential to advancing diagnostic strategies and optimizing management for this potentially treatable condition.
Generative AI Usage
No, did not use generative AI in the drafting or editing in this abstract.
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