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Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report
RATIONALE: Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies. PATIENT CONCERNS: A 41-year-old male patient presented with insidious onset headache of 3-month duration. DIAGNOSES: Contr...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808507/ https://www.ncbi.nlm.nih.gov/pubmed/33466222 http://dx.doi.org/10.1097/MD.0000000000024387 |
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author | Wu, Chi-Shun Wang, Hung-Ping Sung, Sheng-Feng |
author_facet | Wu, Chi-Shun Wang, Hung-Ping Sung, Sheng-Feng |
author_sort | Wu, Chi-Shun |
collection | PubMed |
description | RATIONALE: Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies. PATIENT CONCERNS: A 41-year-old male patient presented with insidious onset headache of 3-month duration. DIAGNOSES: Contrast-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement over bilateral cerebral hemispheres and the tentorium cerebelli. Lumbar puncture showed increased pressure, lymphocytic pleocytosis, and elevated protein level with normal glucose concentration. Blood tests detected elevated erythrocyte sedimentation rate (ESR) and C-reactive protein. Pathological examination of the dura mater from the right frontal convexity disclosed coarse collagenous deposition with focal lymphoid aggregation. After malignancy and infectious etiologies were excluded, a diagnosis of IHP was made. INTERVENTIONS: Oral prednisolone and azathioprine followed by methotrexate were administered. OUTCOMES: During the 7-year follow-up period, although the patient was not totally headache-free, medical therapy significantly reduced the severity of headache. Follow-up MRI studies showed a reduction in meningeal enhancement and serial ESR measurements revealed a trend of improvement. LESSONS: Methotrexate therapy may be considered in cases of steroid-resistant IHP. In addition to clinical evaluation, serial ESR testing may be considered to guide the treatment strategy and assess the response to therapy. |
format | Online Article Text |
id | pubmed-7808507 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-78085072021-01-15 Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report Wu, Chi-Shun Wang, Hung-Ping Sung, Sheng-Feng Medicine (Baltimore) 5300 RATIONALE: Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies. PATIENT CONCERNS: A 41-year-old male patient presented with insidious onset headache of 3-month duration. DIAGNOSES: Contrast-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement over bilateral cerebral hemispheres and the tentorium cerebelli. Lumbar puncture showed increased pressure, lymphocytic pleocytosis, and elevated protein level with normal glucose concentration. Blood tests detected elevated erythrocyte sedimentation rate (ESR) and C-reactive protein. Pathological examination of the dura mater from the right frontal convexity disclosed coarse collagenous deposition with focal lymphoid aggregation. After malignancy and infectious etiologies were excluded, a diagnosis of IHP was made. INTERVENTIONS: Oral prednisolone and azathioprine followed by methotrexate were administered. OUTCOMES: During the 7-year follow-up period, although the patient was not totally headache-free, medical therapy significantly reduced the severity of headache. Follow-up MRI studies showed a reduction in meningeal enhancement and serial ESR measurements revealed a trend of improvement. LESSONS: Methotrexate therapy may be considered in cases of steroid-resistant IHP. In addition to clinical evaluation, serial ESR testing may be considered to guide the treatment strategy and assess the response to therapy. Lippincott Williams & Wilkins 2021-01-15 /pmc/articles/PMC7808507/ /pubmed/33466222 http://dx.doi.org/10.1097/MD.0000000000024387 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | 5300 Wu, Chi-Shun Wang, Hung-Ping Sung, Sheng-Feng Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report |
title | Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report |
title_full | Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report |
title_fullStr | Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report |
title_full_unstemmed | Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report |
title_short | Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report |
title_sort | idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: a case report |
topic | 5300 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808507/ https://www.ncbi.nlm.nih.gov/pubmed/33466222 http://dx.doi.org/10.1097/MD.0000000000024387 |
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