1
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Ang T, Kundu N, Patel S, Tong JY, Selva D. Non-infectious hypertrophic pachymeningitis associated with orbital inflammatory disease: a pooled analysis. Orbit 2024:1-10. [PMID: 39192754 DOI: 10.1080/01676830.2024.2390609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To describe four cases of non-infectious hypertrophic pachymeningitis (HP)-associated with orbital inflammatory disease (OID). This study summarises the clinico-radiological features, outcomes, and management of HP-associated OID. METHODS Retrospective case-series of patients with radiological evidence of HP and OID. Comprehensive literature review of all published English-language non-infectious causes of HP-associated OID. Reference lists were screened for inclusion of relevant articles. RESULTS Thirty-seven cases of HP-associated OID (Mean age: 49.2 ± 17.4 years old; Male: 15) were identified, including four cases from our institution. Aetiologies included ANCA-associated vasculitis (12/37), non-specific/idiopathic (11/37), IgG4/multifocal fibrosclerosis (11/37), neurosarcoidosis (1/37), inflammatory myofibroblastic tumour (1/37), and giant cell arteritis (1/37). Orbital pain, headache, visual deterioration, and cranial nerve palsies were common clinical presentations. Both "focal" and "diffuse" HP were observed, with the most common sign of orbital involvement being an inflammatory orbital mass, typically with orbital apex involvement. Orbital myositis and dacryoadenitis were less common. The cavernous sinus was the most common site of extra-orbital inflammation. There was no single differentiating specific radiological feature between non-specific and specific forms of HP-associated OID. CONCLUSION The clinico-radiological manifestations of HP-associated OID differ from those described in isolated HP or OID. There is no single specific radiological marker differentiating non-specific/idiopathic disease from secondary causes; however, the co-existence of HP in OID should prompt suspicion of an underlying cause. The disease may be refractory or resistant to initial treatment, although guidelines surrounding its management and the long-term prognosis remain to be determined.
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Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, Australia
| | - Naman Kundu
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, Australia
| | - Sandy Patel
- Department of Medical Imaging, The Royal Adelaide Hospital, Adelaide, Australia
| | - Jessica Y Tong
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, Australia
| | - Dinesh Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, Australia
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2
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Shen X, Zhu Z, Li X, Zhang W, Zhang X, Zhang B. Contribution of advanced neuroimaging in diagnosis of cerebral syphilitic gumma: a case report. Front Neurosci 2024; 18:1442176. [PMID: 39206117 PMCID: PMC11349654 DOI: 10.3389/fnins.2024.1442176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
Background Cerebral syphilitic gumma is a rare intracranial infectious disorder. Without a clear history of syphilis and comprehensive serological examinations, it's challenging to diagnose it accurately prior to surgery through routine magnetic resonance imaging (MRI). Advanced neuroimaging techniques have been widely used in diagnosing brain tumors, yet there's limited report on their application in cerebral syphilitic gumma. This report presents a case of an elderly male patient with cerebral syphilitic gumma and analyzes its characteristics of advanced neuroimaging. Case presentation A 68-year-old male patient was admitted to our institution presenting with bilateral hearing loss complicated with continuing headaches without obvious cause. Laboratory tests indicated positive treponema pallidum. Conventional MRI showed nodules closely related to the adjacent meninges in bilateral temporal lobes. The patient underwent surgical resection of the nodule in the right temporal lobe due to the mass effect and the final pathological diagnosis revealed cerebral syphilitic gumma. Conclusions With the return of syphilis in recent years, accurate diagnosis of cerebral syphilitic gumma is a matter of great urgency. Advanced neuro-MRI can serve as a significant complement to conventional MRI examination.
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Affiliation(s)
- Xinyi Shen
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhengyang Zhu
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Li
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wen Zhang
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Zhang
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing, China
- Institute of Brain Science, Nanjing University, Nanjing, China
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3
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Wang J, Wang S, Lin M, Shang X. Two cases of MPO-ANCA-positive hypertrophic pachymeningitis mimicking as intracranial infection. BMC Neurol 2024; 24:283. [PMID: 39138403 PMCID: PMC11320870 DOI: 10.1186/s12883-024-03785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024] Open
Abstract
Hypertrophic pachymeningitis (HP) is a rare disorder marked by thickening of the dura mater due to diverse etiologies. MPO-ANCA-positive HP represents a variant of AAV confined to the central nervous system, distinguished by the presence of serum MPO antibodies. Distinguishing HP triggered by MPO-ANCA from other causes can be challenging.In this study, we present two cases of MPO-ANCA-positive HP initially misdiagnosed as intracranial infections. Case 1 underwent surgery for chronic suppurative otitis media, with histopathological findings revealing inflammatory changes without definitive suppuration. He was presumed to have a secondary intracranial infection resulting from the surgery. However, his condition deteriorated despite two weeks of antibiotic and antiviral treatment. Case 2 presented with headache and was initially suspected of having intracranial Brucellosis given his serum Brucella positivity. Despite treatment for brucellosis, his symptoms persisted, and he developed visual and hearing impairments. Both patients were ultimately diagnosed with MPO-ANCA-positive HP, exhibiting serum MPO antibody positivity. Their symptoms showed improvement with glucocorticoid and immunosuppressive therapy.Based on these observations, we propose that MPO-ANCA-positive HP may initially present as intracranial infection. For HP patients presenting with headache, mastoiditis, otitis media, and visual loss, it is imperative to conduct ANCA antibody-related tests to enhance diagnostic precision.
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Affiliation(s)
- Jirui Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shan Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Meiqing Lin
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China.
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4
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Khaladkar SM, KirdatPatil PP, Dhande A, Jhala NA. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Complicated by Pachymeningitis: A Case Report. Cureus 2024; 16:e64868. [PMID: 39156322 PMCID: PMC11330373 DOI: 10.7759/cureus.64868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune disorder that primarily affects the central nervous system (CNS). We present a unique case of MOGAD complicated by pachymeningitis, which is characterized by inflammation of the dura mater. The clinical presentation included vertigo, nausea, and vomiting. A diagnostic workup confirmed MOGAD complicated by pachymeningitis. This case underscores the diverse clinical manifestations of MOGAD and highlights the challenges in diagnosis and management, particularly when complicated by rare manifestations like pachymeningitis.
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Affiliation(s)
- Sanjay M Khaladkar
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Prajakta P KirdatPatil
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Aryaman Dhande
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Neeha A Jhala
- Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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5
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Lu C, Lv P, Zhu X, Han Y. Cogan's Syndrome Combined with Hypertrophic Pachymeningitis: A Case Report. J Inflamm Res 2024; 17:1839-1843. [PMID: 38523688 PMCID: PMC10961085 DOI: 10.2147/jir.s453071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Cogan's syndrome (CS) is a rare chronic inflammatory disease, characterized by interstitial keratitis and vestibular auditory dysfunction. Hypertrophic pachymeningitis (HP) is a rare chronic aseptic inflammatory disease of the central nervous system. This article reports a patient with CS coexisting with HP. The patient was a 66-year-old male with fever, headache, red eyes, hearing loss, and significantly elevated inflammatory markers. Cerebrospinal fluid examination, blood culture, and tests for autoantibodies such as antinuclear antibodies were negative. Pure tone audiology (PTA) indicated bilateral sensorineural deafness. Both Positron emission tomography-computed tomography (PET/CT) and vascular color Doppler ultrasound suggest the presence of vasculitis. Considering Cogan's syndrome, the patient received 40 mg of methylprednisolone intravenously once daily. The brain's magnetic resonance imaging (MRI) revealed slightly thickened and enhanced dura mater, suggesting HP. The dose of methylprednisolone was increased to 40 mg intravenously every 8 hours, leading to the patient's improved symptoms and decreased inflammatory markers. Both CS and HP are rare chronic inflammatory diseases, and their coexistence is even rarer, with only two reported cases in literature up to date. The coexistence of CS and HP should be considered when the CS patients with headaches do not respond well to treatment.
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Affiliation(s)
- Ci Lu
- Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Panpan Lv
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xiaoying Zhu
- Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yongmei Han
- Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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6
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Enabi J, Sharif MW, Venkatesan R, Kondakindi H, Faheem M. Hypertrophic Pachymeningitis: An Unusual Cause of Headache. Cureus 2024; 16:e53576. [PMID: 38445136 PMCID: PMC10914404 DOI: 10.7759/cureus.53576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/07/2024] Open
Abstract
Hypertrophic pachymeningitis (HP) is a rare condition characterized by inflammation and thickening of the dura mater. It can be idiopathic or secondary to various causes, including infections, tumors, or systemic inflammatory diseases. Diagnosis is challenging due to its rarity and the overlap of symptoms with other conditions. We present the case of a 42-year-old Hispanic woman with diabetes mellitus type 2 and end-stage kidney disease who presented with chest pain, dry cough, mild dyspnea, and chronic occipital headaches. Physical examination revealed cranial VI nerve palsy. Imaging showed pulmonary cavitary lesions and mediastinal lymphadenopathy. Elevated inflammatory markers and positive autoimmune tests, including rheumatoid factor and antineutrophil cytoplasmic antibody (ANCA), led to further investigation. Brain imaging revealed dural thickening, confirming HP. The patient's medical history revealed double ANCA positivity and a lung biopsy confirmed granulomatous pneumonitis. A diagnosis of ANCA-associated vasculitis (granulomatosis with polyangiitis (GPA)) was established, and treatment with rituximab and high-dose corticosteroids led to symptom improvement. GPA rarely involves meningeal inflammation, but severe and persistent headaches are common early symptoms. Inflammatory markers are often elevated, and around two-thirds of HP cases related to GPA have positive serum ANCA. MRI is the primary diagnostic tool, with characteristic findings of dural thickening and contrast enhancement. This case highlights HP as a rare cause of chronic headaches and the importance of a comprehensive medical history in diagnosis. Early recognition and treatment are crucial for improving outcomes in GPA-related HP.
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Affiliation(s)
- Joud Enabi
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | | | - Raksha Venkatesan
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Hema Kondakindi
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Maida Faheem
- Internal Medicine, Midland Memorial Hospital, Midland, USA
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7
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Li Z, Zhang Q, Wang X, Shi F. Granulomatosis with polyangiitis presenting headache: A case report and review of literature. Medicine (Baltimore) 2024; 103:e36972. [PMID: 38215096 PMCID: PMC10783307 DOI: 10.1097/md.0000000000036972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/22/2023] [Indexed: 01/14/2024] Open
Abstract
RATIONALE Central nervous system involvement is a rare manifestation of active-phaselocalized Granulomatosis with polyangiitis (GPA). In hypertrophic dura meningitis, GPA with headache is typical. In this case, cerebral magnetic resonance (MR) enhancement revealed no meningeal thickening, to our knowledge, this manifestation had not been found previously. PATIENT CONCERNS The patient presented to the Rheumatology and Immunology Clinic with severe headache and hearing loss, and central nervous system granulomatosis with polyangiitis was confirmed after a series of examinations. The patient had no significant effect after treatment with cyclophosphamide (CTX), but after the use of rituximab, the headache and hearing loss were significantly improved, and laboratory indicators returned to normal levels. DIAGNOSIS We comprehensively screened for craniocerebral infection and malignant tumors, diagnosed central nervous system granulomatosis with polyangiitis. INTERVENTIONS We gave sequential treatment of rituximab. OUTCOMES All indicators are mostly back to normal when the patient was monitored at the outpatient clinic. LESSONS GPA and severe headache are more prevalent in hypertrophic dura meningitis, but the patient early headache could not be explained by hypertrophic dura meningitis or localized granulomatous lesions that invaded the central nervous system. Patients with severe headaches likely have vascular inflammation and local bone destruction at the base of the skull.
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Affiliation(s)
- Zhao Li
- Department of Rheumatology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Qiushuang Zhang
- Department of Rheumatology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Xuebin Wang
- Department of Rheumatology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Fang Shi
- Department of Rheumatology, Binzhou Medical University Hospital, Binzhou, Shandong, China
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8
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Su J, Ren Q, Li P, Wei W, Liu J, Feng Y, Huang X, Cao Y, Wang W, Wu M, Zhang Q, Wang Z. Clinical Observation of Various Types of Idiopathic Hypertrophic Cranial Pachymeningitis. World Neurosurg 2024; 181:e493-e503. [PMID: 37898275 DOI: 10.1016/j.wneu.2023.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND To assist doctors in making better treatment decisions and improve patient prognosis, it is important to determine which therapy modalities are suitable for various forms of idiopathic hypertrophic cranial pachymeningitis (IHCP). METHODS All cases were received from the hospital medical record system, and some follow-up information was gathered through telephone follow-up. RESULTS A total of 26 patients, 14 men and 12 women, with ages ranging from 20 to 73 years and a mean of 47.42 years, were included in the research. Regular types were less likely to recur than irregular and nodular types, focal types were less likely to recur than diffuse types, and corticosteroid-refractory types were more likely to recur than corticosteroid-sensitive types. CONCLUSIONS The extent and shape of the lesion and susceptibility to corticosteroids are potential factors that could influence recurrence. Futhermore, this paper also proposes the fibroblasts as a new therapeutic target which may improve the quality of prognostic survival of patients.
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Affiliation(s)
- Jinfei Su
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qinzhan Ren
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Pu Li
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junqi Liu
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanjun Feng
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Huang
- Department of Rheumatism and Immunity, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanxiang Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Wu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiuhang Zhang
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlin Wang
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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9
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Yeo J, Yee GT, Seo J, Seo MR, Baek HJ, Choi HJ. Immunoglobulin G4-related hypertrophic pachymeningitis with an isolated scalp mass mimicking a brain tumor: a case report and literature review. JOURNAL OF RHEUMATIC DISEASES 2024; 31:54-58. [PMID: 38130960 PMCID: PMC10730807 DOI: 10.4078/jrd.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 12/23/2023]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disorder associated with fibroinflammatory conditions that can affect multiple organs. Hallmark histopathological findings of IgG4-RD include lymphocytic infiltration of IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. However, little is known about central nervous system involvement of IgG4-RD. Hypertrophic pachymeningitis (HP) has recently been reported as a manifestation of IgG4-RD, which may have previously been demonstrated in a significant percentage of idiopathic cases. Herein, we report a rare case of a 63-year-old male who presented with a scalp mass that mimicked a brain tumor. He was diagnosed with IgG4-related HP (IgG4-RP) after surgery. This case suggests that awareness of a possibility of IgG4-RP in patients with isolated scalp masses, even in the absence of systemic symptoms, is crucial. A combination of careful history taking, evaluation of serum IgG4-levels and imaging as an initial work-up, followed by tissue biopsy, is important for the differential diagnosis of IgG4-RP, malignancy, and other infectious diseases.
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Affiliation(s)
- Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Gi Taek Yee
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jaedeok Seo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Mi Ryoung Seo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyo-Jin Choi
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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10
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Shnyakin PG, Isaeva NV, Severina MI, Karnaukhov DI. [Idiopathic hypertrophic pachymeningitis]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:114-119. [PMID: 38529871 DOI: 10.17116/jnevro2024124031114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The article presents a case of idiopathic hypertrophic pachymeningitis of a 61-year-old male patient with severe cephalgia and progressive neuropathy of the oculomotor nerves. The diagnosis was confirmed by MRI with gadolinium, which revealed thickening of the dura mater with accumulation of paramagnetic in the convexital parts of the frontal and temporal regions, as well as on the base of the skull and tentorium. During the use of pulse therapy with glucocorticosteroids (GCS) the symptoms regressed, but when the therapy was stopped, there was a relapse of ptosis and oculomotor abnormalities on the other side followed by a slower effect of GCS therapy. The article also presents a brief review of current knowledge about this pathology.
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Affiliation(s)
- P G Shnyakin
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Regional Clinical Hospital, Krasnoyarsk, Russia
| | - N V Isaeva
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Regional Clinical Hospital, Krasnoyarsk, Russia
| | - M I Severina
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
- Regional Clinical Hospital, Krasnoyarsk, Russia
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11
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Gupta A, Um D, Samant R, Hasbun R, Samudralwar RD, Sriwastava S, Gupta RK. Idiopathic Hypertrophic Spinal Pachymeningitis. J Med Cases 2023; 14:405-412. [PMID: 38186557 PMCID: PMC10769654 DOI: 10.14740/jmc4149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 01/09/2024] Open
Abstract
Hypertrophic pachymeningitis (HP) is a rare presentation with duramater thickening and fibrosis which can result in cranial or spinal compressive disease. Most cases of spinal HP require surgical management. We present an uncommon case of idiopathic hypertrophic spinal pachymeningitis (IHSP) in a 40-year-old male who showed complete improvement to steroids without any further relapses. The patient presented with bilateral upper limb weakness with magnetic resonance imaging (MRI) spine showing diffuse dural thickening of the entire spine with cervical cord compression. He had an extensive workup for underlying etiology and worsening symptoms until he was diagnosed with IHSP. Later, he was started on high-dose steroids with good response and no relapse after 2 years. A descriptive analysis of IHSP cases since 2009 including ours showed that it usually occurs after 50s with female preponderance. Weakness and sensory loss are the most common complaints with 50% patients showing clinical signs of myelopathy like hyperreflexia, clonus, Babinski sign and sensory level. Cerebrospinal fluid (CSF) and inflammatory markers like erythrocytic sedimentation rate (ESR) and C-reactive protein (CRP) can be used to assess disease progression and prognosis. Surgical removal of HP followed by steroids is the best line of management while steroids alone can be tried in cases where clinical signs of myelopathy are absent.
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Affiliation(s)
- Ashutosh Gupta
- McGovern Medical School, UT Health Science Center at Houston, Houston, TX 77030, USA
| | - Daniel Um
- McGovern Medical School, UT Health Science Center at Houston, Houston, TX 77030, USA
| | - Rohan Samant
- Department of Radiology, UT Health Science Center at Houston, TX 77030, USA
| | - Rodrigo Hasbun
- Department of Infectious Disease, UT Health Science Center at Houston, TX 77030, USA
| | | | - Shitiz Sriwastava
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Rajesh K. Gupta
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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12
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Carabenciov ID, Madhavan AA, Cutsforth-Gregory JK. B-Cell Lymphoma Presenting With Marked Intracranial Pachymeningitis. Mayo Clin Proc 2023; 98:1888-1889. [PMID: 38044004 DOI: 10.1016/j.mayocp.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 12/05/2023]
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13
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Ikeda J, Shimojima Y, Yamada A, Sekijima Y. Quantitative evaluation of the thickened dura mater impacting clinical signs in immune-mediated hypertrophic pachymeningitis. J Neurol Sci 2023; 453:120780. [PMID: 37689000 DOI: 10.1016/j.jns.2023.120780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE This study evaluated the volume of thickened dura mater lesions and their impact on clinical findings in immune-mediated hypertrophic pachymeningitis (HP). METHODS The volume of contrast-enhanced dura mater on magnetic resonance imaging was evaluated using the imaging feature quantification system in 19 patients with immune-mediated HP, including 12 with antineutrophil cytoplasmic antibody-related, 4 with IgG4-related, and 3 with idiopathic HP, as well as 10 with multiple sclerosis (MS) as controls. The implications of HP volume on neurological manifestations and cerebrospinal fluid (CSF) laboratory markers were statistically analyzed in patients with immune-mediated HP. RESULTS The volumes of the contrast-enhanced dura mater in the convexity, cranial fossa, and tentorium cerebelli were significantly higher in patients with immune-mediated HP than in those with MS. Among patients with immune-mediated HP, those with cranial nerve (CN) VIII neuropathy had a significantly higher volume of the contrast-enhanced dura mater in the cranial fossa than those without CN VIII neuropathy. The volume of the contrast-enhanced dura mater in the tentorium cerebelli was positively correlated with CSF protein levels. CONCLUSION Quantification of the thickened dura mater is useful for elucidating the relationship with the clinical findings in immune-mediated HP. Thickened dura mater lesions in the cranial fossa may be implicated in the development of CN VIII neuropathy. The enlargement of HP lesions in the tentorium cerebelli can increase CSF protein levels.
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Affiliation(s)
- Junji Ikeda
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
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Yu H, Lu C, Duan W, Dong Y, Wang Z, Wang X, Jian F. A selected case series of idiopathic hypertrophic pachymeningitis in a single center: Pathological characteristics and case-oriented review. J Neuroimmunol 2023; 383:578191. [PMID: 37660537 DOI: 10.1016/j.jneuroim.2023.578191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/06/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
Hypertrophic pachymeningitis (HP) is a relatively rare disease of the central nervous system characterized by local or diffuse fibrous thickening of the dura mater. At present, there is still insufficient research on the pathogenesis and treatment strategies of this disease. We reported a continuous case series of seven patients with idiopathic HP (IHP), and also details one case of immunoglobulin G4-related HP requiring surgical intervention. Early diagnosis and appropriate surgical intervention for IHP could prevent the progression of permanent neurological damage and spinal cord paraplegia.
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Affiliation(s)
- Huaxiao Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Chunli Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Yachao Dong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Zuowei Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China.
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China.
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15
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Lichtblau N, Aliaga-Arias J, Kalaitzoglou D, Bodi I, Ashkan K, Bhangoo R, Vergani F, Joe D, Stanton B, Galloway J, Carlton-Jones L, Lavrador JP. IgG4-related hypertrophic pachymeningitis with chronic subdural haematoma. Pract Neurol 2023; 23:441-445. [PMID: 37460210 DOI: 10.1136/pn-2023-003750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 10/04/2023]
Abstract
Hypertrophic pachymeningitis is a rare disorder of the dura mater of the spine or brain. It can be caused by inflammatory, infective or neoplastic conditions or can be idiopathic. We report a man with hypertrophic pachymeningitis and bilateral chronic subdural haematoma caused by IgG4-related disease. We highlight the diagnostic challenges and discuss possible underlying mechanisms of subdural haematoma formation in inflammatory conditions. Isolated IgG4-related hypertrophic pachymeningitis with chronic subdural haematoma is very rare; previously reported cases have suggested a possible predilection for men in their sixth decade, presenting with headache as the dominant symptom. Given the rarity and complexity of the condition, it should be managed in a multidisciplinary team setting.
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Affiliation(s)
- Nicole Lichtblau
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jahard Aliaga-Arias
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita degli Studi di Brescia, Brescia, Italy
| | | | - Istvan Bodi
- Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ranj Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Dorothy Joe
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
- Neuropsychiatry Service, South London and Maudsley NHS Trust, London, UK
| | - James Galloway
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Lalani Carlton-Jones
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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16
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Das S, Ray BK. The Spectrum of Intracranial Hypertrophic Pachymeningitis at an Eastern Indian Tertiary Care Center. Ann Indian Acad Neurol 2023; 26:678-689. [PMID: 38022439 PMCID: PMC10666889 DOI: 10.4103/aian.aian_561_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Hypertrophic pachymeningitis (HP) is a treatable, rare inflammatory disease, either primary or secondary to systemic causes. Aims To characterize the etiology, clinical manifestations, and treatment outcomes of HP patients and determine the factors influencing the radiological resolution of the pachymeningeal enhancement and recurrence of symptoms within the follow-up period. Materials and Methods We collected data for this prospective observational study between March 1, 2021 and May 31, 2022, at the Bangur Institute of Neurosciences, Kolkata, and the patients were followed for a 6-month period. Demographic, clinical, laboratory, and treatment-related data were collected. A univariate logistic regression model was used for comparison between patients with and without radiological resolution of pachymeningitis and between patients with and without symptom recurrence. Results Among 44 patients, the male: female ratio was 1.2:1. The median age at disease onset was 35.5 (28.5-49.5) years. The etiologies were idiopathic (56.8%), tuberculosis (22.8%), immunoglobulin G subtype 4 (IgG4) disease (9.2%), other infections (6.8%), and neoplastic (4.4%). Headache was the most common presentation (95.4%), followed by cranial neuropathies (68.2%). Optic and oculomotor neuropathies were the most common. In terms of radiological features, 27.27, 29.54, and 43.18% of patients had diffuse, focal regular, and focal irregular enhancement, respectively. Temporal (50%), followed by cavernous sinus (38.63%) enhancement, was the most common. Recurrence occurred in 36 and 50% of idiopathic and IgG4-related HP cases, respectively. Mycophenolate mofetil was added to their steroid regimen with no further recurrences. Conclusion The cohort had a marked absence of (antineutrophil cytoplasmic antibodies) ANCA-associated HP. The severity of clinical manifestations or distribution of pachymeningitis did not differ significantly among the etiological groups. The presence of idiopathic etiology and focal regular enhancement had a significantly higher chance of radiological resolution. The response to therapy was satisfactory. Recurrence was significantly related to shorter steroid courses (
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Affiliation(s)
- Suman Das
- Department of Neuromedicine, North Bengal Medical College, Darjeeling District, West Bengal, India
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
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17
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Shen J, Lackey E, Shah S. Neurosarcoidosis: Diagnostic Challenges and Mimics A Review. Curr Allergy Asthma Rep 2023; 23:399-410. [PMID: 37256482 PMCID: PMC10230477 DOI: 10.1007/s11882-023-01092-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE OF REVIEW Neurosarcoidosis is a rare manifestation of sarcoidosis that is challenging to diagnose. Biopsy confirmation of granulomas is not sufficient, as other granulomatous diseases can present similarly. This review is intended to guide the clinician in identifying key conditions to exclude prior to concluding a diagnosis of neurosarcoidosis. RECENT FINDINGS Although new biomarkers are being studied, there are no reliable tests for neurosarcoidosis. Advances in serum testing and imaging have improved the diagnosis for key mimics of neurosarcoidosis in certain clinical scenarios, but biopsy remains an important method of differentiation. Key mimics of neurosarcoidosis in all cases include infections (tuberculosis, fungal), autoimmune disease (vasculitis, IgG4-related disease), and lymphoma. As neurosarcoidosis can affect any part of the nervous system, patients should have a unique differential diagnosis tailored to their clinical presentation. Although biopsy can assist with excluding mimics, diagnosis is ultimately clinical.
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Affiliation(s)
- Jeffrey Shen
- Duke Department of Medicine, Division of Rheumatology and Immunology, Duke University, 40 Duke Medicine Cir Clinic 1J, Durham, NC, 27710, USA.
| | - Elijah Lackey
- Duke Department of Neurology, Duke University, 40 Duke Medicine Cir Clinic 1L, Durham, NC, 27701, USA
| | - Suma Shah
- Duke Department of Neurology, Duke University, 40 Duke Medicine Cir Clinic 1L, Durham, NC, 27701, USA
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18
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Yoshimura Y, Kanda-Kikuchi J, Hara T, Sugimoto I. Idiopathic hypertrophic pachymeningitis in a patient with a history of diffuse large B cell lymphoma. BMJ Case Rep 2023; 16:e254847. [PMID: 37316284 PMCID: PMC10277052 DOI: 10.1136/bcr-2023-254847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
A man in his early 70s with a 4-year history of diffuse large B cell lymphoma (DLBCL) was admitted to our hospital with diplopia and achromatopsia. Neurological examination revealed visual impairment, ocular motility disorder and diplopia on looking to the left. Blood and cerebrospinal fluid investigations showed no significant findings. MRI revealed diffusely thickened dura mater and contrast-enhanced structures in the left apical orbit, consistent with hypertrophic pachymeningitis (HP). We performed an open dural biopsy to distinguish the diagnosis from lymphoma. The pathological diagnosis was idiopathic HP, and DLBCL recurrence was ruled out. Following methylprednisolone pulse and oral prednisolone therapy, his neurological abnormalities gradually receded. Open dural biopsy played an important role not only in diagnosing idiopathic HP but also in relieving the pressure on the optic nerve.
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Affiliation(s)
- Yusuke Yoshimura
- Department of Neurology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Junko Kanda-Kikuchi
- Department of Neurology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
| | - Takayuki Hara
- Department of Neurosurgery, Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - Izumi Sugimoto
- Department of Neurology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan
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19
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Rizzo SA, Flanagan EP, Trejo-Lopez JA, Toledano M, Chia NH. Clinical Reasoning: New-Onset Diplopia and Headache in a Patient With Metastatic Breast Cancer. Neurology 2023; 100:927-931. [PMID: 36805434 PMCID: PMC10186217 DOI: 10.1212/wnl.0000000000206856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/07/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Skylar A Rizzo
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
| | - Jorge A Trejo-Lopez
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
| | - Michel Toledano
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN.
| | - Nicholas H Chia
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
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20
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Al-Qaysi G, Abu-Abaa M, Abdulsahib A, Ruppel A, Prabhakaran S. Spinal Hypertrophic Pachymeningitis in Antineutrophilic Cytoplasmic Antibody-Negative Vasculitis: A Case Report. Cureus 2023; 15:e39121. [PMID: 37332435 PMCID: PMC10273173 DOI: 10.7759/cureus.39121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Hypertrophic pachymeningitis (HPM) is a rare but extremely debilitating disease. It is even rarer for HPM to be seen in association with antineutrophil cytoplasmic antibody (ANCA)-negative vasculitis. In this case, we are presenting HPM that was diagnosed in a 28-year-old female patient who presented with worsening back pain. Imaging revealed dural-based enhancing masses affecting the thoracic spinal cord with compression. Infectious etiologies were ruled out and a total of three biopsies failed to show any evidence of granulomatous inflammation, malignancy, or evidence of immunoglobulin G4-related disease. ANCA was negative on repeated testing. The patient was managed with repeated short courses of steroids that resulted in symptomatic control as well as radiological stability of the disease. This is an extremely rare case of atypical presentation of spinal HPM that is likely associated with granulomatous and polyangiitis without other manifestations of the disease except for nasal septal perforation. This case is a supplement to a limited body of knowledge and established cases of HPM in ANCA-negative, ANCA-associated vasculitis.
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Affiliation(s)
- Ghassan Al-Qaysi
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Mohammad Abu-Abaa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Ali Abdulsahib
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Andreas Ruppel
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
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21
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Shimojima Y, Sekijima Y. Hypertrophic pachymeningitis in ANCA-associated vasculitis: Clinical and immunopathological features and insights. Autoimmun Rev 2023; 22:103338. [PMID: 37062439 DOI: 10.1016/j.autrev.2023.103338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
Hypertrophic pachymeningitis (HP) is an inflammatory disorder characterized by intracranial and spinal thickened dura mater, leading to several neurological manifestations including headaches, cranial neuropathies, seizures, and sensorimotor disorders. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a crucial disease that is implicated in the development of immune-mediated HP. HP is observed throughout the clinical course of AAV, and 3%-4% of patients with AAV experience HP as the initial clinical episode. However, patients with ANCA-related HP are unclassifiable in the classification criteria of AAV when HP is the only manifestation, suggesting that ANCA-related HP can be identified as a central nervous system-limited type of AAV. Among patients with AAV, those who develop HP have predominantly been classified as having granulomatosis with polyangiitis (GPA). Myeloperoxidase-ANCA positivity has been more frequently demonstrated than proteinase 3-ANCA positivity in patients with ANCA-related HP. The ear, nose, and throat manifestations, such as otitis media, sinusitis, and mastoiditis, as well as mucous membranes/eyes manifestations including sudden visual loss, are robustly associated with HP in AAV. The histology of thickened dura mater tissues includes fibrotic changes and infiltration of several immunocompetent cells, but the typical findings of GPA, such as granulomatous inflammation with necrotizing vasculitis, are not observed in all patients with ANCA-related HP. Corticosteroids are the first-line therapy for ANCA-related HP, while the concomitant use of immunosuppressive agents including cyclophosphamide, methotrexate, and mycophenolate mofetil, is an ideal strategy for achieving remission. Rituximab is a useful agent in refractory ANCA-related HP.
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Affiliation(s)
- Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
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22
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Gautier F, Neumann L, Adle-Biassete H, Rubenstein E, Bernat AL, Chimon A, Mouly S, Sène D, Comarmond C. Pachymeningitis associated with IgG4-related disease and ANCA positivity: Case report and review of the literature. Autoimmun Rev 2023; 22:103285. [PMID: 36738953 DOI: 10.1016/j.autrev.2023.103285] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Hypertrophic pachymeningitis is a rare clinical disorder involving localized or diffuse thickening of the dura mater. Considering pachymeningitis is both in the clinical spectrum of IgG4-RD and ANCA vasculitis (specifically granulomatosis with polyangiitis), an overlap syndrome is discussed. METHODS We report a case of hypertrophic pachymeningitis revealed by headache and cranial nerve dysfunction, and coexistence of biopsy-proven IgG4-RD pachymeningitis and MPO-ANCA positivity. Furthermore, all cases previously reported in the literature of pachymeningitis with IgG4-RD and presence of ANCA were analyzed. RESULTS Thirteen patients with pachymeningitis, IgG4-RD and ANCA were analyzed. Patients with HP-related IgG4 and ANCA are mainly male (8, 62%). Median age at diagnosis was 64 years. Main clinical manifestations at diagnosis were localized to the head and neck with headaches (10, 77%), cranial nerve dysfunction (7, 54%), hearing impairment (6, 46%) and vertigo (4, 31%). Except 1 patient with diffuse aortitis, no other systemic manifestation was observed at diagnosis and during follow-up. Serum IgG4 was often elevated (11, 85%) and ANCA was mainly with myeloperoxidase specificity (11, 85%). Seven patients had cerebrospinal fluid analyse with lymphocytic pleocytosis in 5 cases (71%), elevated proteins in 4 cases (57%), positive oligoclonal bands in 3 cases (42%) and decreased glucose in one case (14%). On the MRI, the thickening of the dura mater concerned most often the posterior fossa, in 7 cases (54%). Among 10 cases with histological findings, all showed increased IgG4-positivity of plasma cells, 50% lymphocytic infiltrate but none presented the three major histological criteria of IgG4-related disease. Three (30%) showed histological signs of vasculitis with vascular wall damage and/or giant cells. Among the 12 patients treated with steroid therapy, a clinical improvement was noted in 11 cases (92%). Relapse occurred during tapering in 4 patients (33%). An immunosuppressive drug was added in 2nd line for 7 cases (54%), with a clinical improvement in all. CONCLUSION Pachymeningitis with IgG4 and ANCA seems a localized disease to the head and neck. Leptomeningeal biopsy commonly found IgG4 criteria and no vasculitis. All patients responded well to steroid therapy and immunosuppressive drugs, especially rituximab, with clinical and radiological improvement but relapse and/or sequelae are not uncommon.
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Affiliation(s)
- Félicien Gautier
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Lisa Neumann
- Department of Neurology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Homa Adle-Biassete
- Department of Pathology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Emma Rubenstein
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Alice Chimon
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Stéphane Mouly
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Damien Sène
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, 75010 Paris, France.
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23
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Tanaviriyachai T, Chinvattanachot G, Piyapromdee U, Sirisanthiti P. IgG4-Related Spinal Hypertrophic Pachymeningitis With Neurological Deficit: A Report of 2 Cases. JBJS Case Connect 2023; 13:01709767-202306000-00042. [PMID: 37262188 DOI: 10.2106/jbjs.cc.23.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CASE Immunoglobulin G4 (IgG4)-related spinal hypertrophic pachymeningitis (IgG4-RHP) is a rare disease characterized by diffuse inflammatory fibrosis of the spinal dura mater that can cause myelopathy and neurological deficits. Here, we report 2 cases in which both patients presented with myelopathy and paraplegia. They underwent decompressive laminectomy, and the diagnoses were confirmed through histopathologic examination. Both patients received prednisolone postoperatively, which was subsequently switched to methotrexate for maintenance. CONCLUSION Two cases of IgG4-RHP were successfully treated with decompressive laminectomy and combined therapy with steroids and other immunosuppressive agents.
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Affiliation(s)
- Terdpong Tanaviriyachai
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Guntarat Chinvattanachot
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Urawit Piyapromdee
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Piyaporn Sirisanthiti
- Department of Hematology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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24
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Tarumi M, Abe N, Atsumi T. Progressive cognitive dysfunction with subdural polycystic hygroma and systemic inflammation under immunosuppressive therapy. Int J Rheum Dis 2023; 26:808-809. [PMID: 36876742 DOI: 10.1111/1756-185x.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Masato Tarumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuya Abe
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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25
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Nicho N, Nozawa T, Murase A, Hayashibe R, Tanoshima R, Okubo R, Hattori S, Nishimura K, Ohya T, Ito S. Difficulties of diagnosing idiopathic hypertrophic pachymeningitis in children: Case report and literature review. Mod Rheumatol Case Rep 2023; 7:233-236. [PMID: 35348716 DOI: 10.1093/mrcr/rxac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
Hypertrophic pachymeningitis (HP) is a rare inflammatory disorder characterised by local or diffuse thickening of the cranial and spinal dura mater. HP occurs owing to idiopathic or secondary causes, including autoimmune disease, infection, and trauma. HP has mainly been reported in adults, with few reported cases in children. We encountered an 11-year-old boy with idiopathic HP who presented with chronic inflammation and daily occipital headache. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) helped us to diagnose him with HP. He was successfully treated with corticosteroids and azathioprine with no recurrence. We also conducted a literature review of childhood-onset HP and found only 16 cases, including our patient. Seven patients had idiopathic HP, and the remaining nine had secondary HP, including two with rheumatic disease. The most common clinical symptoms were headache (68.8%) and cranial nerve-related symptoms (68.8%). Inflammatory laboratory markers were elevated in 60% of patients with available data. Fifteen cases were diagnosed using Gd-enhanced MRI. The main initial treatment was steroids and/or immunosuppressants, to which 87.5% of patients responded. However, two patients with HP associated with trauma and neuroblastoma (12.5%) died, and seven patients (43.8%) had left cranial nerve-related sequelae. As the prognosis for childhood HP is poor, early diagnosis and treatment are essential. Children with headache, cranial nerve symptoms, and elevated inflammatory marker levels should be suspected of having HP and Gd-enhanced MRI should be considered.
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Affiliation(s)
- Naoki Nicho
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Tomo Nozawa
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Ayako Murase
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Ren Hayashibe
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Reo Tanoshima
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Risa Okubo
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Seira Hattori
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Kenichi Nishimura
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Takashi Ohya
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Kolb C, Müller M, Kohnen T. [Overlap syndrome of giant cell arteritis and pachymeningitis]. DIE OPHTHALMOLOGIE 2022; 119:1149-1151. [PMID: 35089414 DOI: 10.1007/s00347-022-01578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/01/2022] [Accepted: 01/09/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Carolin Kolb
- Klinik für Augenheilkunde, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Michael Müller
- Klinik für Augenheilkunde, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Thomas Kohnen
- Klinik für Augenheilkunde, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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27
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Hundia R, Jayasinghe A, Tighe D. Hypertrophic pachymeningitis: An odontogenic origin? ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Locations and Predictive Factors of Hypertrophic Pachymeningitis in Otitis Media With Antineutrophil Cytoplasmic Antigen-Associated Vasculitis. Otol Neurotol 2022; 43:e835-e840. [PMID: 35960882 DOI: 10.1097/mao.0000000000003610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the locations and predictive factors of hypertrophic pachymeningitis (HP), a serious central complication of otitis media with antineutrophil cytoplasmic antigen-associated vasculitis (OMAAV). STUDY DESIGN Retrospective study. SETTING University hospital. PATIENTS Thirty-six patients with OMAAV underwent contrast-enhanced magnetic resonance imaging (CE-MRI) of the brain, of whom 18 and 18 had or did not have HP, respectively. MAIN OUTCOME MEASURES The location of HP lesions, which were detected as dural thickening on CE-MRI, was reviewed. Clinical characteristics, laboratory data, and audiometric data before treatment were correlated with the occurrence of HP. RESULTS HP lesions were most frequently observed in the middle cranial fossa, followed by the internal auditory meatus, tentorium cerebelli, and posterior cranial fossa, which were adjacent to the middle ear primary lesion. Headache was more frequently observed in patients with HP than without HP. The neutrophil-to-lymphocyte ratio (NLR) of the HP (+) group (median, 3.91; interquartile range, 2.50-6.06) was higher than that of the HP (-) group (median, 2.40; interquartile range, 2.01-3.03). The area under the receiver operating characteristic curve for the NLR was 0.741. An NLR of 3.46 had the highest sensitivity (61.1%) and specificity (94.4%) for predicting HP. Other markers of systemic inflammation and comorbidities of systemic diseases were not different between the groups. CONCLUSIONS HP may not be a systemic manifestation of OMAAV but may be related to local lesions in the adjacent brain. A high NLR may be a predictive factor for comorbid HP. Therefore, CE-MRI should be considered for patients with a high NLR.
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Vankadari K, Alwala S, Kumar K, Ram S. Hypertrophic Pachymeningitis Presenting as “Eyebrows” Sign on 18F FDG PET/CT. World J Nucl Med 2022; 21:236-238. [PMID: 36060081 PMCID: PMC9436508 DOI: 10.1055/s-0042-1750014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypertrophic pachymeningitis refers to linear or nodular thickening of the dura mater covering the brain and spinal cord following various inflammatory/infective processes. Usually, magnetic resonance imaging brain shows uniform thickening with enhancement of involved meninges. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings of pachymeningitis are rarely reported in literature. We describe the PET/CT findings of a patient with hypertrophic pachymeningitis involving the bilateral supraorbital regions depicting as “eyebrows” on brain maximum intensity projection image.
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Affiliation(s)
- Kousik Vankadari
- Department of Nuclear Medicine, Yashoda Hospital, Secunderabad, Telangana, India
| | - Surendar Alwala
- Department of Radiology, Yashoda Hospital, Secunderabad, Telangana, India
| | - Komal Kumar
- Department of Neurology, Yashoda Hospital, Secunderabad, Telangana, India
| | - Sai Ram
- Department of Nuclear Medicine, Yashoda Hospital, Secunderabad, Telangana, India
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30
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Shimojima Y, Kishida D, Ichikawa T, Kida T, Yajima N, Omura S, Nakagomi D, Abe Y, Kadoya M, Takizawa N, Nomura A, Kukida Y, Kondo N, Yamano Y, Yanagida T, Endo K, Hirata S, Matsui K, Takeuchi T, Ichinose K, Kato M, Yanai R, Matsuo Y, Nishioka R, Okazaki R, Takata T, Ito T, Moriyama M, Takatani A, Miyawaki Y, Ito-Ihara T, Kawaguchi T, Kawahito Y, Sekijima Y. Hypertrophic pachymeningitis in ANCA-associated vasculitis: a cross-sectional and multi-institutional study in Japan (J-CANVAS). Arthritis Res Ther 2022; 24:204. [PMID: 35999568 PMCID: PMC9396769 DOI: 10.1186/s13075-022-02898-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the characteristics of hypertrophic pachymeningitis (HP) in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), using information from a multicenter study in Japan. METHODS We analyzed the clinical information of 663 Asian patients with AAV (total AAV), including 558 patients with newly diagnosed AAV and 105 with relapsed AAV. Clinical findings were compared between patients with and without HP. To elucidate the relevant manifestations for HP development, multivariable logistic regression analyses were additionally performed. RESULTS Of the patients with AAV (mean age, 70.2 ± 13.5 years), HP was noted in 30 (4.52%), including 20 (3.58%) with newly diagnosed AAV and 10 (9.52%) with relapsed AAV. Granulomatosis with polyangiitis (GPA) was classified in 50% of patients with HP. A higher prevalence of GPA was significantly observed in patients with HP than in those without HP in total AAV and newly diagnosed AAV (p < 0.001). In newly diagnosed AAV, serum proteinase 3 (PR3)-ANCA positivity was significantly higher in patients with HP than in those without HP (p = 0.030). Patients with HP significantly had ear, nose, and throat (ENT) (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.03-2.14, p = 0.033) and mucous membrane/eye manifestations (OR 5.99, 95% CI 2.59-13.86, p < 0.0001) in total AAV. Moreover, they significantly had conductive hearing loss (OR 11.6, 95% CI 4.51-29.57, p < 0.0001) and sudden visual loss (OR 20.9, 95% CI 5.24-85.03, p < 0.0001). CONCLUSION GPA was predominantly observed in patients with HP. Furthermore, in newly diagnosed AAV, patients with HP showed significantly higher PR3-ANCA positivity than those without HP. The ear and eye manifestations may be implicated in HP development.
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Affiliation(s)
- Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takashi Kida
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Omura
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daiki Nakagomi
- Department of Rheumatology, University of Yamanashi Hospital, Yamanashi, Japan
| | - Yoshiyuki Abe
- Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo, Japan
| | - Masatoshi Kadoya
- Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Naoho Takizawa
- Department of Rheumatology, Chubu Rosai Hospital, Nagoya, Japan
| | - Atsushi Nomura
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Yuji Kukida
- Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan
| | - Naoya Kondo
- Department of Nephrology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Takuya Yanagida
- Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan
| | - Koji Endo
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kiyoshi Matsui
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryo Yanai
- Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yusuke Matsuo
- Department of Rheumatology, Tokyo Kyosai Hospital, Tokyo, Japan.,Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Nishioka
- Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ryota Okazaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tomoaki Takata
- Division of Gastroenterology and Nephrology, Tottori University, Yonago, Japan
| | - Takafumi Ito
- Division of Nephrology, Shimane University Hospital, Izumo, Shimane, Japan
| | - Mayuko Moriyama
- Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ayuko Takatani
- Rheumatic Disease Center, Sasebo Chuo Hospital, Nagasaki, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiko Ito-Ihara
- The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Kawaguchi
- Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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31
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Yao Y, Xu Y, Li X, Song T, Xu W, Duan Y, Liu Y, Zhang X, Tian DC. Clinical, imaging features and treatment response of idiopathic hypertrophic pachymeningitis. Mult Scler Relat Disord 2022; 66:104026. [DOI: 10.1016/j.msard.2022.104026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
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32
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Otaka Y, Harada Y, Shimizu T. Hypertrophic pachymeningitis in the context of the treatment of polymyalgia rheumatica. BMJ Case Rep 2022; 15:e250450. [PMID: 35725281 PMCID: PMC9214400 DOI: 10.1136/bcr-2022-250450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yumi Otaka
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan
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33
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Shao W, Tian C, Gao L, Cui B, Shi Q. Rapid bilateral visual loss as the initial clinical manifestation in idiopathic hypertrophic cranial pachymeningitis. Clin Case Rep 2022; 10:e05825. [PMID: 35572097 PMCID: PMC9074037 DOI: 10.1002/ccr3.5825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/29/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
A 59‐year‐old patient presented with 4‐day acute painless bilateral visual loss, MRI results showed dura enhancement of the frontal, anterior cranial fossa. The patient was considered to have idiopathic hypertrophic cranial pachymeningitis based on laboratory tests and MRI data. After treatment with hormones, the visual acuity obviously improved.
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Affiliation(s)
- Weiyang Shao
- Ophthalmology Department The Third Medical Center of Chinese PLA General Hospital Beijing China
- Ophthalmology Department The Sixth Medical Center of Chinese PLA General Hospital Beijing China
| | - Chunyu Tian
- Ophthalmology Department The Third Medical Center of Chinese PLA General Hospital Beijing China
| | - Lixiong Gao
- Ophthalmology Department The Third Medical Center of Chinese PLA General Hospital Beijing China
| | - Bei Cui
- Ophthalmology Department The Third Medical Center of Chinese PLA General Hospital Beijing China
| | - Qian Shi
- Ophthalmology Department The Third Medical Center of Chinese PLA General Hospital Beijing China
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34
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Tan C, Zhong M, Yao Z, Hong S, Jiang L, Jiang Y. Anti-GFAP Antibody-Associated Hypertrophic Pachymeningitis. Neuropediatrics 2022; 53:143-145. [PMID: 35148545 DOI: 10.1055/s-0042-1742718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an inflammatory central nervous system (CNS) disorder that usually presents as steroid responsive encephalitis, meningitis, myelitis, or meningoencephalomyelitis. Hypertrophic pachymeningitis (HP) is an uncommon disorder that causes a localized or diffuse thickening of the dura mater. Depending on the etiology, HP can be idiopathic or secondary to a wide variety of other diseases. There are no reports of autoimmune GFAP astrocytopathy presenting as HP. METHODS In this case report, we describe a rare case of pediatric HP possibly associated with anti-GFAP antibody. RESULTS A 13-year-old previously healthy girl presented with headache for nearly 8 months with left-sided peripheral facial palsy and left-sided abductor nerve palsy in the second month of course. Magnetic resonance imaging (MRI) of the brain revealed contrast enhancement of hypertrophic dura mater. Anti-GFAPα antibodies were positive in serum and cerebrospinal fluid. The patient improved clinically after steroid treatment with partial resolution of abnormal intracranial MRI lesions. CONCLUSION The present study suggests that HP may be one of the clinical phenotypes for autoimmune GFAP astrocytopathy or GFAP antibody is a biomarker for HP.
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Affiliation(s)
- Chengbing Tan
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders Chongqing, People's Republic of China.,Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, People's Republic of China
| | - Min Zhong
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders Chongqing, People's Republic of China.,Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, People's Republic of China
| | - Zhengxiong Yao
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders Chongqing, People's Republic of China.,Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, People's Republic of China
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders Chongqing, People's Republic of China.,Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, People's Republic of China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders Chongqing, People's Republic of China.,Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, People's Republic of China
| | - Yan Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders Chongqing, People's Republic of China.,Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, People's Republic of China
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Ishii S, Sugawara S, Yamakuni R, Sekino H, Ito H. Hypertrophic Pachymeningitis Demonstrated by Whole-Body 67Ga Scintigraphy. Clin Nucl Med 2022; 47:e149-e151. [PMID: 34284475 DOI: 10.1097/rlu.0000000000003833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hypertrophic pachymeningitis is a rare inflammatory process characterized by thickening of the dura mater that can be idiopathic or secondary to a variety of conditions such as ANCA-related vasculitis, IgG4-related disease, Sjögren syndrome, rheumatoid arthritis, sarcoidosis, and infections. It can cause various neurological alterations such as headache, cranial nerve disorder, cerebellar disorder, sensory impairment, and weakness. Brain MRI is useful for imaging diagnosis of hypertrophic pachymeningitis, showing focal thickening and enhancement of the dura mater. Here we report 4 cases of idiopathic hypertrophic pachymeningitis where 67Ga clearly accumulated in the dura mater.
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Affiliation(s)
- Shiro Ishii
- From the Department of Radiology, Fukushima Medical University, Fukushima, Japan
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36
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Goglin S, Cho TA. Clinical approach to neuro-rheumatology. J Neurol Sci 2021; 431:120048. [PMID: 34768134 DOI: 10.1016/j.jns.2021.120048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 01/13/2023]
Abstract
Recognizing the neurologic manifestations of systemic rheumatologic diseases and certain isolated autoimmune neurologic diseases poses challenges to the clinician. Using a systematic approach allows the clinician to diagnose these conditions more readily and to initiate treatment more rapidly. Specific neurological syndromes frequently associated with rheumatologic or specific autoimmune conditions can suggest the diagnosis. A targeted history and examination can identify neurological and systemic clues that help to identify an underlying rheumatologic condition. Judicious use of laboratory and radiographic studies can help confirm suspected diagnoses. This article will review some of the neurological syndromes typical of rheumatologic disease and outline an approach to evaluating for unknown rheumatologic disease in this context.
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Affiliation(s)
- Sarah Goglin
- Division of Rheumatology, Department of Medicine, University of California, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Tracey A Cho
- Neuroimmunology Division, Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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37
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Çavdar S, Sürücü S, Özkan M, Köse B, Malik AN, Aydoğmuş E, Tanış Ö, Lazoğlu İ. Comparison of the Morphologic and Mechanical Features of Human Cranial Dura and Other Graft Materials Used for Duraplasty. World Neurosurg 2021; 159:e199-e207. [PMID: 34920156 DOI: 10.1016/j.wneu.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to compare the thickness and mechanical properties of the frontal; parietal; temporal; occipital human dura; autogenous grafts (facia lata, temporal fascia, galea aponeurotica); and artificial dura. METHODS Sagittal and transverse dura samples were obtained from standard regions of the cranial dura from 30 autopsies for histologic and mechanical property measurements. Identical measurements were made for the autogenous grafts artificial dura, and the results were statistically analyzed. RESULTS The thickness of the temporal (0.35 ± 0.11 mm), parietal (0.44 ± 0.13 mm), frontal (0.38 ± 0.12 mm), and occipital (0.46 ± 0.18 mm) dura showed regional variations. The parietal and occipital dura were significantly thicker than the temporal dura. The occipital dura was considerably thicker than the frontal dura. The frontal and temporal dura of males were significantly thicker than females. The sagittal maximum tensile force measurements were significantly greater than transverse, for the frontal, temporal, and occipital dura. The stiffness measurements in sagittal direction were greater than the measurements in transverse direction for the frontal dura. The mechanical properties and thickness of the autogenous and artificial dura were not similar to the human dura. CONCLUSIONS The thickness and mechanical properties of the regional cranial dura should be taken into consideration for a better cure and fewer complications. The mechanical properties of sagittal and transverse dura should be kept in mind for the preference of dura material. The present study's data can pave the way to produce artificial regional dura by mimicking the thickness and mechanical properties of the human dura.
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Affiliation(s)
- Safiye Çavdar
- Department of Anatomy, Koç University, School of Medicine, Rumelifener Yolu, Istanbul, Turkey.
| | - Selçuk Sürücü
- Department of Anatomy, Koç University, School of Medicine, Rumelifener Yolu, Istanbul, Turkey
| | - Mazhar Özkan
- Department of Anatomy, Tekirdağ Namık Kemal University, School of Medicine, Istanbul, Turkey
| | - Büşra Köse
- Department of Anatomy, Koç University, School of Medicine, Rumelifener Yolu, Istanbul, Turkey
| | - Anjum Naeem Malik
- Manufacturing and Automation Research Center, Mechanical Engineering Department, Koç University, Istanbul, Turkey
| | - Evren Aydoğmuş
- Department of Neurosurgery, Dr. Lütfi Kırdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Özgül Tanış
- Department of Anatomy, Koç University, School of Medicine, Rumelifener Yolu, Istanbul, Turkey
| | - İsmail Lazoğlu
- Manufacturing and Automation Research Center, Mechanical Engineering Department, Koç University, Istanbul, Turkey
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López-Simón E, Corriols-Noval P, Castillo-Ledesma N, Rodríguez-Martín M, Morales-Angulo C. Audiovestibular Symptoms in Patients With Idiopathic Hypertrophic Pachymeningitis: Systematic Literature Review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:387-393. [PMID: 34844678 DOI: 10.1016/j.otoeng.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is called idiopathic hypertrophic pachymeningitis (IHP). Audiovestibular symptoms are infrequent and the pathogenesis is still unclear. MATERIALS AND METHODS A systematic literature review of cases with IHP and vestibular symptoms from 2000 to February 2020 was performed. PRISMA Checklist was followed and PubMED database, Web of Science and Cochrane library were searched. We report a case of an adolescent with a diagnosis of vestibular neuritis in the context of IHP attended in our clinic. RESULTS We reviewed 5 articles related to IHP and vestibular disorders. A total of 7 cases (5 women and 2 men), with ages between 27 and 68 years with IHP were found. They all had audiovestibular symptoms. In contrast to our patient, uni or bilateral neurosensorial hearing loss was reported in all cases. Furthermore, there is no other case report published describing the association between IHP and vestibular neuritis. High dose steroids improved symptoms in 85.7% of the patients. CONCLUSION Vestibular symptoms in IHP are uncommon and the pathogenesis is still debatable. Entrapment of nerves in the internal auditory canal and secondary neuronal damage could be suspected as the main cause of hearing and vestibular loss.
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Affiliation(s)
- Eugenia López-Simón
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain.
| | - Patricia Corriols-Noval
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Nathalia Castillo-Ledesma
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Minerva Rodríguez-Martín
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Carmelo Morales-Angulo
- Unidad de Otoneurología, Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander (Cantabria), Spain
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Nomura S, Shimojima Y, Kondo Y, Kishida D, Sekijima Y. Hypertrophic pachymeningitis in polyarteritis nodosa: a case-based review. Clin Rheumatol 2021; 41:567-572. [PMID: 34725743 DOI: 10.1007/s10067-021-05971-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022]
Abstract
Hypertrophic pachymeningitis (HP) is a rare neurological disorder with focal or diffuse thickening of the dura mater, which usually causes headache, cranial neuropathies, seizures, and motor or sensory impairments. The development of HP is attributed to an immune-mediated mechanism, and some autoimmune diseases have been implicated in the development of HP. Herein, we describe the case of a 73-year-old woman with persistent headache ascribable to HP, which developed approximately 3 years after a diagnosis of polyarteritis nodosa (PAN). She was treated with high-dose corticosteroid and cyclophosphamide that resulted in immediate disappearance of headache and improved radiological findings of thickened dura mater. In addition, she was subsequently administered methotrexate, ultimately resulting in maintenance of remission and regular reduction of prednisolone. In our review of published English articles, only two cases of HP in patients with PAN have been reported to date, suggesting that HP is a rare complication in PAN. However, it should be recognized that HP may develop as a neurological involvement related to PAN.
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Affiliation(s)
- Shun Nomura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Yasufumi Kondo
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Luo Y, Tang Q, Zhao S, Wang Z, Liu L. A Rare Cause of Chronic Headache: Idiopathic Hypertrophic Cranial Pachymeningitis with Secondary Cerebral Venous Sinus Thrombosis. PAIN MEDICINE 2021; 22:2410-2413. [PMID: 33565595 DOI: 10.1093/pm/pnab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yayin Luo
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qizhen Tang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuqi Zhao
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhe Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Libo Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Shiraishi W, Tsujimoto Y, Shiraishi T. Pathological findings of hypertrophic pachymeningitis associated with eosinophilic granulomatosis with polyangiitis. BMJ Case Rep 2021; 14:14/9/e243395. [PMID: 34544704 PMCID: PMC8454454 DOI: 10.1136/bcr-2021-243395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The most common neurological manifestation of eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is mononeuritis multiplex caused by small-vessel vasculitis. In contrast, central nervous system involvement is rare. Among EGPA-associated central nervous system disorders, there are only a few reported cases of hypertrophic pachymeningitis (HP). Here, we report a patient with EGPA with headache and ophthalmoplegia who presented with HP and had a dural biopsy. The biopsy specimen showed lymphocytic inflammatory cell infiltration without EGPA-specific findings, that is, eosinophilic infiltration, granuloma or angiitis. To the best of our knowledge, there are no previous reports of EGPA-associated HP pathology. Here, we report the first case presentation of a patient with EGPA-associated HP with pathological findings.
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Affiliation(s)
- Wataru Shiraishi
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan
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Izuka S, Yamashita H, Takahashi Y, Kaneko H. Hypertrophic Pachymeningitis in Eosinophilic Granulomatosis with Polyangiitis. Mod Rheumatol Case Rep 2021; 6:80-82. [PMID: 34480185 DOI: 10.1093/mrcr/rxab009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/29/2021] [Accepted: 06/11/2021] [Indexed: 11/12/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is one of the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV), which is characterized by systemic small vessels vasculitis with associated eosinophilia. Hypertrophic pachymeningitis (HP) is an inflammatory disease in which the cerebral or spinal dura mater is thickened. AAV other than EGPA may sometimes develop HP; however, patients with EGPA rarely develop HP. This is the case of myeloperoxidase-ANCA-positive EGPA that presented with headache and blurred vision and was diagnosed with HP. It was successfully treated with pulsed steroid therapy and intravenous cyclophosphamide without any relapse for more than four years.
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Affiliation(s)
- Shinji Izuka
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuko Takahashi
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kaneko
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
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Sanfiel Delgado A, Rodríguez-Alfonso B, Tibisay Vazquez Benitez G, Ruiz Molina A, Mitjavila Casanovas M. Infección parasitaria y tuberculosis como hallazgos inesperados en la evaluación de paquimeningitis hipertrófica mediante 18FDG-PET/TC. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remn.2020.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sanfiel Delgado A, Rodríguez-Alfonso B, Tibisay Vazquez Benitez G, Ruiz Molina A, Mitjavila Casanovas M. Unexpected concomitant parasitic infection and tuberculosis in the evaluation of hypertrophic pachymeningitis with 18F-FDG PET/CT: [[es]]Infección parasitaria y tuberculosis como hallazgos inesperados en laevaluación de paquimeningitis hipertrófica mediante 18FDG-PET/TC. Rev Esp Med Nucl Imagen Mol 2021; 40:315-317. [PMID: 34425973 DOI: 10.1016/j.remnie.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- A Sanfiel Delgado
- Departamento de Medicina Nuclear, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - B Rodríguez-Alfonso
- Departamento de Medicina Nuclear, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
| | - G Tibisay Vazquez Benitez
- Departamento de Patología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - A Ruiz Molina
- Departamento de Neurología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - M Mitjavila Casanovas
- Departamento de Medicina Nuclear, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
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Dutta P, Anand K. Tolosa-Hunt Syndrome: A Review of Diagnostic Criteria and Unresolved Issues. J Curr Ophthalmol 2021; 33:104-111. [PMID: 34409218 PMCID: PMC8365592 DOI: 10.4103/joco.joco_134_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose: To review the diagnostic criteria for Tolosa–Hunt syndrome (THS) and utility of recent modifications. Methods: We searched PubMed for keywords Tolosa Hunt and magnetic resonance imaging. We compared the three editions of International Classification of Headache Disorders and isolated case reports and case series with the assessment of cavernous internal carotid artery (ICA) caliber to find the prevalence of vascular anomalies. We also evaluated cases of THS with the involvement of extracavernous structures and the possible role of idiopathic hypertrophic pachymeningitis (HP). Cases diagnosed falsely as THS were also reviewed for the presence of atypical features and relevance of criterion D. We assessed nonconforming cases (those with normal neuroimaging benign THS) and idiopathic inflammatory orbital pseudotumor (IIPO). Results: Vascular abnormalities were found in 36.36% of THS cases. Benign THS may also show changes in ICA caliber. Evidence suggestive of idiopathic HP could be found in 57% of cases with the involvement of extracavernous structures, such as facial nerve and pituitary gland. Both THS and IIPO are steroid-responsive pathologies with similar clinical and radiological features. False-positive diagnosis of THS results from early labeling, based solely on clinical features and symptom resolution after steroid therapy. Conclusions: Benign THS may be a result of limitation of resolution of available neuroimaging technique or early testing. Early and late vascular changes can be seen in both THS and its benign variant; some of them are not innocuous. THS may be considered a type of focal idiopathic HP. IIPO may represent an anterior variant of THS. In the absence of histopathological diagnosis, steroid-induced resolution of symptoms should be confirmed radiologically and followed-up.
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Affiliation(s)
- Paromita Dutta
- Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
| | - Kamlesh Anand
- Guru Nanak Eye Centre, Department of Ophthalmology, Maulana Azad Medical College, New Delhi, India
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Hutto SK, Maher MD, Miloslavsky EM, Venna N. Nodular Pachymeningitis Associated With Relapsing Polychondritis and Crohn Disease Responsive to Adalimumab and Prednisone. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1022. [PMID: 34078656 PMCID: PMC8176555 DOI: 10.1212/nxi.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
Objectives To review the previous literature on the associations of pachymeningitis with Crohn disease (CD) and relapsing polychondritis (RP) and to describe a new case occurring in association with both in addition to highlighting its positive response to steroid and adalimumab treatment. Methods We review the patient's clinical presentation, diagnostic workup (serum and CSF testing), and MRI findings in detail and chronicle the response of the pachymeningitis to intensive immunotherapy. We contrast this case against previous reports of pachymeningitis occurring in association with RP and inflammatory bowel disease that were found on PubMed. Results Only 2 cases of ulcerative colitis and 5 cases of RP were found in association with pachymeningitis; there were no cases in association with CD. Our patient presented with symptoms isolated to a steroid-responsive headache in the setting of normal neurologic and rheumatologic examinations. Her preceding history was notable for long-standing CD and increasingly active symptoms referable to RP. Focal nodular pachymeningitis was seen overlying the left hemisphere on brain MRI. An extensive serum and CSF workup and body fluorodeoxyglucose-PET scan failed to identify an alternative etiology beyond her underlying autoimmune inflammatory disorders. After adding prednisone and adalimumab to her preexisting treatment of methotrexate, she responded dramatically both clinically and radiographically. Conclusions Although exceptionally rare, pachymeningitis may occur as a neuroinflammatory complication of CD and RP.
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Affiliation(s)
- Spencer K Hutto
- From the Division of Neuroimmunology and Neuroinfectious Diseases (S.K.H., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Division of Neuroradiology (M.D.M), Department of Radiology, Massachusetts General Hospital, Boston; and Division of Rheumatology, Allergy and Immunology (E.M.M), Department of Medicine, Massachusetts General Hospital, Boston.
| | - Mary D Maher
- From the Division of Neuroimmunology and Neuroinfectious Diseases (S.K.H., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Division of Neuroradiology (M.D.M), Department of Radiology, Massachusetts General Hospital, Boston; and Division of Rheumatology, Allergy and Immunology (E.M.M), Department of Medicine, Massachusetts General Hospital, Boston
| | - Eli M Miloslavsky
- From the Division of Neuroimmunology and Neuroinfectious Diseases (S.K.H., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Division of Neuroradiology (M.D.M), Department of Radiology, Massachusetts General Hospital, Boston; and Division of Rheumatology, Allergy and Immunology (E.M.M), Department of Medicine, Massachusetts General Hospital, Boston
| | - Nagagopal Venna
- From the Division of Neuroimmunology and Neuroinfectious Diseases (S.K.H., N.V.), Department of Neurology, Massachusetts General Hospital, Boston; Division of Neuroradiology (M.D.M), Department of Radiology, Massachusetts General Hospital, Boston; and Division of Rheumatology, Allergy and Immunology (E.M.M), Department of Medicine, Massachusetts General Hospital, Boston
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Chirakkal P, Al Hail ANI, Ayinikunnan A. Malignant otitis externa masquerading as nasopharyngeal carcinoma - A diagnostic conundrum. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Zielke T, Kim M, Simon JE, Borys E, Prabhu VC, Pappu S. Hypertrophic cranial pachymeningitis and orbital apex syndrome secondary to infection of the eye: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20168. [PMID: 35854865 PMCID: PMC9245743 DOI: 10.3171/case20168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hypertrophic cranial pachymeningitis is a rare inflammatory disorder characterized by thickening of the dura mater and multiple cranial neuropathies. Although an infectious etiology may be present, often no specific cause is discovered. OBSERVATIONS The authors described a 71-year-old man with progressive right eye vision loss, ptosis, and complete ophthalmoplegia with imaging findings suggestive of hypertrophic cranial pachymeningitis. Extensive studies, including cerebrospinal fluid studies, showed negative results. Blood serum, cell-free evaluation, and paraffin-embedded dural tissue testing had positive results for Pseudomonas aeruginosa, which allowed treatment tailored to the organism and a salutary clinical outcome. LESSONS The constellation of neurological and radiological findings may make a diagnosis difficult in an inflammatory setting. The most precise methodology for establishing a diagnosis involves sampling the dura and testing it for infectious pathology. However, if results are inconclusive, further cell-free serum sampling with next-generation sequencing is a viable option for identifying pathogens with infectious concerns. This case highlighted the importance of multimodality studies for identifying a targetable pathogen.
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Affiliation(s)
- Tara Zielke
- Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Miri Kim
- Departments of Neurological Surgery and
| | | | - Ewa Borys
- Loyola Stritch School of Medicine, Maywood, Illinois; and
| | | | - Suguna Pappu
- Departments of Neurological Surgery and
- Department of Neurological Surgery, Edward J. Hines VA Hospital, Hines, Illinois
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Role of Optic Nerve Sheath Fenestration in Inflammatory Pachymeningitis Causing Visual Impairment. Ophthalmic Plast Reconstr Surg 2021; 37:e63-e65. [PMID: 32732548 DOI: 10.1097/iop.0000000000001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Eye disease due to pachymeningitis caused by immunoglobulin G4-related disease (IgG4-RD) is a rare occurrence. Here, the authors report a unique case of a patient presenting with visual loss from raised intracerebral pressure from pachymeningitis most likely related to IgG4-RD. The patient was treated with acetazolamide and steroids, and an optic nerve sheath fenestration was performed to successfully save the patients vision.
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Nakajima I, Taniguchi Y, Mizobuchi T, Kishimoto T, Fukushima A, Fukuda K. Optic Neuropathy with Headache and Palpable Temporal Arteries Due to Hypertrophic Pachymeningitis Rather than Giant Cell Arteritis. Ocul Immunol Inflamm 2021; 30:1515-1518. [PMID: 33793376 DOI: 10.1080/09273948.2021.1881561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To report a case of optic neuropathy diagnosed by color Doppler ultrasonography and Gadolinium-enhanced cerebral magnetic resonance imaging (MRI).Case report: A 79-year-old woman presented with headache and vision loss in her left eye. Although her bilateral temporal arteries were palpable and rope-like, color Doppler ultrasonography showed normal flow in both arteries with no signs of arteritis. MRI revealed increased enhancement of the pachymeninges enveloping both cerebral hemispheres, suggestive of hypertrophic pachymeningitis.Conclusion: Symptoms and laboratory data are similar for both hypertrophic pachymeningitis and giant cell arteritis (GCA). The present case suggests the utility of ultrasonography and MRI as rapid, convenient, and noninvasive tools for differential diagnosis of optic neuropathy.
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Affiliation(s)
- Isana Nakajima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, and Nephrology, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
| | - Tomoka Mizobuchi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
| | - Atsuki Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
| | - Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku City, Kochi, Japan
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