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Aseptic meningitis in rheumatoid arthritis after anti-TNF administration: a case-based literature review

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Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by articular and extra-articular manifestations. Among extra-articular involvement, rheumatoid meningitis (RM) is a rare condition, which may exhibit variable symptoms including headache, focal and/or generalized neurologic deficits. It may develop as the preceding manifestation of RA or occur at any time of the disease course. Some drugs used for the treatment of RA may give rise to aseptic meningitis or create a tendency to infectious meningitis due to their immunosuppressive effect. All these possibilities may lead to difficulties in the differential diagnosis. Achieving a diagnosis in a short time is crucial in terms of prognosis. Here, we would like to report a case with longstanding RA manifested by left-sided weakness and seizure shortly after initiating etanercept (ETA) therapy. ETA-induced meningitis was confirmed with appropriate diagnostic tools. Our aim with this case-based review is to attract the attention of this rare condition and discuss diagnostic challenges.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, School of Medicine, Eskişehir Osmangazi University, Eskişehir, 26480, Turkey

    Reşit Yıldırım, Döndü Üsküdar Cansu & Cengiz Korkmaz

  2. Department of Pathology, Eskişehir Osmangazi University, Eskişehir, Turkey

    Deniz Arık

  3. Department of Radiology, Eskişehir Osmangazi University, Eskişehir, Turkey

    Suzan Saylısoy

Authors
  1. Reşit Yıldırım
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  2. Döndü Üsküdar Cansu
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  3. Deniz Arık
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  4. Suzan Saylısoy
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  5. Cengiz Korkmaz
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Contributions

Study concept and design: RY, DUC, and CK; analysis and interpretation of data: RY, DUC, DA, SS and CK; drafting of the manuscript: RY, DUC, DA, SS and CK, critically revision of the manuscript for important intellectual content: RY, DUC, and CK; final approval of the version to be published: RY, DUC, DA, SS and CK.

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Correspondence to Reşit Yıldırım.

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All procedures performed in studies involving human participants were by the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Yıldırım, R., Cansu, D.Ü., Arık, D. et al. Aseptic meningitis in rheumatoid arthritis after anti-TNF administration: a case-based literature review. Rheumatol Int 41, 1845–1853 (2021). https://doi.org/10.1007/s00296-021-04822-6

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  • DOI: https://doi.org/10.1007/s00296-021-04822-6

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