Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry
Abstract Background Rheumatoid meningitis (RM) is a rare disorder that often develops during a remission phase of rheumatoid arthritis (RA). This is the first study to demonstrate differences in regard to immunological disturbance between blood and cerebrospinal fluid (CSF) samples obtained from a p...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | Journal of Neuroinflammation |
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| Online Access: | http://link.springer.com/article/10.1186/s12974-018-1196-3 |
| _version_ | 1818910153375744000 |
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| author | Miki Oono Yoshimasa Fujita Nobuaki Uchida Ukichiro Kawai Michiyo Fujita-Nakata Megumi Nakanishi Mitsuru Sanada Shigemi Nagayama Makoto Matsui |
| author_facet | Miki Oono Yoshimasa Fujita Nobuaki Uchida Ukichiro Kawai Michiyo Fujita-Nakata Megumi Nakanishi Mitsuru Sanada Shigemi Nagayama Makoto Matsui |
| author_sort | Miki Oono |
| collection | DOAJ |
| description | Abstract Background Rheumatoid meningitis (RM) is a rare disorder that often develops during a remission phase of rheumatoid arthritis (RA). This is the first study to demonstrate differences in regard to immunological disturbance between blood and cerebrospinal fluid (CSF) samples obtained from a patient with RM using flow cytometry. Case presentation A 36-year-old woman with RA and generalized myasthenia gravis (MG) developed RM during a remission phase. Although both RA and MG were stable and well controlled, she noticed fever, headache, and transient sensory disturbance. Blood and CSF examination findings suggested aseptic meningitis, while brain magnetic resonance imaging revealed restricted portions of meningitis and associated cortical lesions, compatible with a diagnosis of RM. The dose of oral prednisolone was increased, which ameliorated the symptoms within 1 week along with improvement in CSF findings. This patient exhibited features of RM that were manifested in a manner independent of the activity of RA. An investigation of cellular immunity using CSF specimens with flow cytometry showed differences in regard to the pathogenesis of inflammation in the CSF as compared to outside of the central nervous system. In contrast to results obtained with paired blood samples, CSF cells at the peak stage of RM showed a marked increase in CCR3+ Th2 cells and marked decrease in CD8+ cells, suggesting an immunoregulatory disturbance in the CSF. Those findings indicated a CSF-specific activation of humoral immunity, resulting in augmentation of meningeal inflammation, as shown by excess synthesis of intrathecal IgG and markedly elevated interleukin-6 level. Results of the present detailed investigation of lymphocyte subsets revealed a discrepancy regarding the process of inflammation in this RM patient between CSF and blood samples. Conclusions RM is not a simple reflection of the immune status of RA, as the pathogenesis seems related to, at least in part, CSF-specific immunological dysregulation. |
| first_indexed | 2024-12-19T22:38:17Z |
| format | Article |
| id | doaj.art-f412fb5f9d8e499598106cc58c32aaa9 |
| institution | Directory Open Access Journal |
| issn | 1742-2094 |
| language | English |
| last_indexed | 2024-12-19T22:38:17Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Neuroinflammation |
| spelling | doaj.art-f412fb5f9d8e499598106cc58c32aaa92022-12-21T20:03:09ZengBMCJournal of Neuroinflammation1742-20942018-05-011511610.1186/s12974-018-1196-3Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometryMiki Oono0Yoshimasa Fujita1Nobuaki Uchida2Ukichiro Kawai3Michiyo Fujita-Nakata4Megumi Nakanishi5Mitsuru Sanada6Shigemi Nagayama7Makoto Matsui8Department of Neurology, Kanazawa Medical UniversityDepartment of Hematology and Immunology, Kanazawa Medical UniversityDepartment of Neurology, Kanazawa Medical UniversityDepartment of Neurology, Kanazawa Medical UniversityDepartment of Neurology, Kanazawa Medical UniversityDepartment of Neurology, Kanazawa Medical UniversityDepartment of Neurology, Kanazawa Medical UniversityDepartment of Neurology, Kanazawa Medical UniversityDepartment of Neurology, Kanazawa Medical UniversityAbstract Background Rheumatoid meningitis (RM) is a rare disorder that often develops during a remission phase of rheumatoid arthritis (RA). This is the first study to demonstrate differences in regard to immunological disturbance between blood and cerebrospinal fluid (CSF) samples obtained from a patient with RM using flow cytometry. Case presentation A 36-year-old woman with RA and generalized myasthenia gravis (MG) developed RM during a remission phase. Although both RA and MG were stable and well controlled, she noticed fever, headache, and transient sensory disturbance. Blood and CSF examination findings suggested aseptic meningitis, while brain magnetic resonance imaging revealed restricted portions of meningitis and associated cortical lesions, compatible with a diagnosis of RM. The dose of oral prednisolone was increased, which ameliorated the symptoms within 1 week along with improvement in CSF findings. This patient exhibited features of RM that were manifested in a manner independent of the activity of RA. An investigation of cellular immunity using CSF specimens with flow cytometry showed differences in regard to the pathogenesis of inflammation in the CSF as compared to outside of the central nervous system. In contrast to results obtained with paired blood samples, CSF cells at the peak stage of RM showed a marked increase in CCR3+ Th2 cells and marked decrease in CD8+ cells, suggesting an immunoregulatory disturbance in the CSF. Those findings indicated a CSF-specific activation of humoral immunity, resulting in augmentation of meningeal inflammation, as shown by excess synthesis of intrathecal IgG and markedly elevated interleukin-6 level. Results of the present detailed investigation of lymphocyte subsets revealed a discrepancy regarding the process of inflammation in this RM patient between CSF and blood samples. Conclusions RM is not a simple reflection of the immune status of RA, as the pathogenesis seems related to, at least in part, CSF-specific immunological dysregulation.http://link.springer.com/article/10.1186/s12974-018-1196-3Rheumatoid meningitisMyasthenia gravisRheumatoid arthritisFlow cytometryCerebrospinal fluidInterleukin-6 |
| spellingShingle | Miki Oono Yoshimasa Fujita Nobuaki Uchida Ukichiro Kawai Michiyo Fujita-Nakata Megumi Nakanishi Mitsuru Sanada Shigemi Nagayama Makoto Matsui Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry Journal of Neuroinflammation Rheumatoid meningitis Myasthenia gravis Rheumatoid arthritis Flow cytometry Cerebrospinal fluid Interleukin-6 |
| title | Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry |
| title_full | Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry |
| title_fullStr | Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry |
| title_full_unstemmed | Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry |
| title_short | Rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis—detailed analysis of intracranial inflammation using flow cytometry |
| title_sort | rheumatoid meningitis developed in patient with stable rheumatoid arthritis and myasthenia gravis detailed analysis of intracranial inflammation using flow cytometry |
| topic | Rheumatoid meningitis Myasthenia gravis Rheumatoid arthritis Flow cytometry Cerebrospinal fluid Interleukin-6 |
| url | http://link.springer.com/article/10.1186/s12974-018-1196-3 |
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