Posterior Reversible Encephalopathy Syndrome and Persistent Central Nervous System Inflammation in Rheumatoid Arthritis-Coincidence or Consequence? A Case Report

可逆性後腦腦病變與持續性中樞系統發炎並存於一位類風濕關節炎患者－是巧合或因果必然？病例報告

鄒榮吉(Jung-Chi Tsou) ； 許世斌(Shi-Ping Hsu)

《南臺灣醫學雜誌》 5卷2期 (2009/12) Pp. 98-104

https://doi.org/10.6726/MJST.200912_5(2).0008

摘要

一位五十一歲女性罹患類風濕性關節炎， 以遲發性癲癇、頭痛、暈眩、協調失衡、與視力障礙來表現大腦後側可逆性腦病變症候群。腦部電腦斷層與磁振造影顯示典型右側後腦顳葉頂葉區域病變。此病人除了使用環孢靈-A之外並無其他易誘發大腦後側可逆性腦病變症候群之因子。病人停止使用環孢靈-A後一個月症狀僅改善些許。腦脊機髓液檢查發現持續性白血球、蛋白質增高，與單株性球蛋白病變。因考慮可能是類風濕性關節炎併中樞神經侵犯，投與脈衝式類固醇治療後， 臨床症狀與影像異常即完全消失。我們報告此病例，並推測類風濕性關節炎併持續性低度中樞系統發炎可能加成環孢靈-A之血管性水腫效應，進而惡化大腦後側可逆性腦病變症候群之影像與臨床症候。

關鍵字

大腦後側可逆性腦病變症候群 ； 類風濕性關節炎 ； 腦膜炎 ； 環孢靈-A

並列摘要

A 51-year-old woman with rheumatoid arthritis presented posterior reversible encephalopathy syndrome (PRES) which manifested as late onset seizure, headache, dizziness, ataxia and visual disturbance. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed characteristic lesions in the right posterior tempore-parietal region. There was no other known precipitating factor except cyclosporine A exposure. The symptoms improved modestly after withdrawal of cyclosporine A for one month. Persistent lymphocytic pleocytosis and monoclonal pattern of hyperproteinrrachia were found by cerebrospinal fluid analysis. Steroid pulse therapy was administrated for possible central involvement by rheumatoid arthritis. The image abnormalities and clinical symptoms disappeared. We report this case and suggest that persistent low grade central nervous system inflammation caused by rheumatoid arthritis may have synergistic effect of vasogenic edema and worsened cyclosporine A related clinicoradiological findings.

並列關鍵字

posterior reversible encephalopathy ； rheumatoid arthritis ； meningitis ； cyclosporine A