Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Wu, Chi-Shun, Wang, Hung-Ping, Sung, Sheng-Feng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
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
_version_ 1783636913304895488
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
work_keys_str_mv AT wuchishun idiopathichypertrophicpachymeningitiswithanticardiolipinantibodyacasereport
AT wanghungping idiopathichypertrophicpachymeningitiswithanticardiolipinantibodyacasereport
AT sungshengfeng idiopathichypertrophicpachymeningitiswithanticardiolipinantibodyacasereport