Skip to main content

Granulomatous meningitis due to rheumatoid arthritis


Meningoencephalitis is a rare but aggressive complication of rheumatoid arthritis (RA). The most common complications of RA occur in the severe and chronic stages of the disease. Only a few cases have been reported in the literature. The symptoms are usually nonspecific, and arthralgia may be missing. Brain MRI and CSF analysis are useful to guide the diagnosis. However, a biopsy is required to demonstrate the existence of granulomatous lesions and the lack of mycobacterium infection. Early detection is essential to prevent neurological complications. Treatment consists of intravenous high doses of corticoid followed by oral tapered doses associated with immunosuppressive therapy. The present case is remarkable by the presence of granulomatous lesions in the lung and meninges and the dramatic improvement after immunosuppressive therapy.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Tan HJ, Raymond AA, Phadke PP, Rozman Z (2004) Rheumatoid pachymeningitis. Singap Med J 45:337–339

    CAS  Google Scholar 

  2. Chou RC, Henson JW, Tian D, Hedley-Whyte ET, Reginato AM (2006) Successful treatment of rheumatoid meningitis with cyclophosphamide but not infliximab. Ann Rheum Dis 65:1114–1116

    PubMed  Article  CAS  Google Scholar 

  3. Bathon JM, Moreland LW, DiBartolomeo AG (1989) Inflammatory central nervous system involvement in rheumatoid arthritis. Semin Arthritis Rheum 18:258–266

    PubMed  Article  CAS  Google Scholar 

  4. Puechal X (2004) Atteintes neurologiques au cours des maladies systémiques. In: Déchy E, Wechsler B, Hausfater P, Rancurel G, Piette JC (eds) Atteintes neurologiques au cours des maladies systémiques. Médecin-Sciences, Flammarion, Paris

    Google Scholar 

  5. Ikeda K, Takazawa T, Ito H, Ishikawa Y, Miura K et al (2010) Rheumatoid leptomeningitis: radiological alteration of cerebral hypoperfusion and subarachnoid lesions. Intern Med 49:1911–1916

    PubMed  Article  Google Scholar 

  6. Zheng RL, Lv H, Zhang W, Yu MX, Yuan Y (2006) A rheumatoid leptomeningitis: a case report and literature review. Beijing Da Xue Xue Bao 38:324–325

    PubMed  Google Scholar 

  7. Aguilar-Amat MJ, Abenza-Abildua MJ, Vivancos F, Rodriguez de Rivera FJ, Morales-Bastos C et al (2011) Rheumatoid meningitis mimicking progressive supranuclear palsy. Neurologist 17:136–140

    PubMed  Article  Google Scholar 

  8. Jones SE, Belsley NA, McLoud TC, Mullins ME (2006) Radiologic-pathologic conference of the Massachusetts General Hospital. Am J Roentgenol 186:1181–1183

    Article  Google Scholar 

  9. Inan AS, Masatlioglu S, Ozyurek SC, Engin D, Erdem I (2009) Unusual central nervous system involvement of rheumatoid arthritis: successful treatment with steroid and azathioprine. Rheumatol Int 31(10):1383–1385

    PubMed  Article  Google Scholar 

  10. Matsushima M, Yaguchi H, Niino M, Akimoto-Tsuji S, Yabe I et al (2010) MRI and pathological findings of rheumatoid meningitis. J Clin Neurosci 17:129–132

    PubMed  Article  Google Scholar 

  11. Koide R, Isoo A, Ishii K, Uruha A, Bandoh M (2009) Rheumatoid leptomeningitis: rare complication of rheumatoid arthritis. Clin Rheumatol 28:1117–1119

    PubMed  Article  Google Scholar 

  12. Ellman P, Cudkowicz L, Elwood JS (1954) Widespread serous membrane involvement by rheumatoid nodules. J Clin Pathol 7:239–244

    PubMed  Article  CAS  Google Scholar 

  13. Kurne A, Karabudak R, Karadag O, Yalcin-Cakmakli G, Karli-Oguz K et al (2009) An unusual central nervous system involvement in rheumatoid arthritis: combination of pachymeningitis and cerebral vasculitis. Rheumatol Int 29:1349–1353

    PubMed  Article  Google Scholar 

  14. Shimada K, Matsui T, Kawakami M, Hayakawa H, Futami H et al (2009) Diffuse chronic leptomeningitis with seropositive rheumatoid arthritis: report of a case successfully treated as rheumatoid leptomeningitis. Mod Rheumatol 19:556–562

    PubMed  Article  Google Scholar 

  15. Hasiloglu ZI, Asik M, Erer B, Dikici AS, Altintas A et al (2011) Magnetic resonance imaging of rheumatoid meningitis: A case report and literature review. Rheumatol Int (Epub 2011.09.09)

  16. Kim HY, Park JH, Oh HE, Han HJ, Shin DI et al (2011) A case of rheumatoid meningitis: pathologic and magnetic resonance imaging findings. Neurol Sci 32(6):1191–1194

    PubMed  Article  Google Scholar 

  17. Matsuura D, Ohshita T, Nagano Y, Ohtsuki T, Kohriyama T et al (2008) Case of rheumatoid meningitis: findings on diffusion-weighted image versus flair image. Rinsho Shinkeigaku 48:191–195

    PubMed  Article  Google Scholar 

  18. Zolcinski M, Bazan-Socha S, Zwolinska G, Musial J (2008) Central nervous system involvement as a major manifestation of rheumatoid arthritis. Rheumatol Int 28:281–283

    PubMed  Article  CAS  Google Scholar 

  19. Cellerini M, Gabbrielli S, Maddali Bongi S, Cammelli D (2001) MRI of cerebral rheumatoid pachymeningitis: report of two cases with follow-up. Neuroradiology 43:147–150

    PubMed  Article  CAS  Google Scholar 

  20. Kato T, Hoshi K, Sekijima Y, Matsuda M, Hashimoto T et al (2003) Rheumatoid meningitis: an autopsy report and review of the literature. Clin Rheumatol 22:475–480

    PubMed  Article  Google Scholar 

  21. Marotte H, Charrin JE, Miossec P (2001) Infliximab-induced aseptic meningitis. Lancet 358:1784

    PubMed  Article  CAS  Google Scholar 

  22. Luessi F, Sollors J, Muller H, Stoeter P, Sommer C et al (2009) Infliximab in the treatment of rheumatoid meningoencephalitis. J Neurol 256:2094–2096

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

None declared.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Patrice Laloux.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Duray, M.C., Marchand, E., Gohy, S. et al. Granulomatous meningitis due to rheumatoid arthritis. Acta Neurol Belg 112, 193–197 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Rheumatoid arthritis
  • Meningoencephalitis
  • Meningitis
  • Granulomatous lesion
  • Immunosuppressive treatment