Abstract

Hypertrophic cranial pachymeningitis is a rare inflammatory disease with diffused involvement of the dura and also is a rare disorder of diverse etiology. Based on anatomic site cases of hypertrophic pachymeningitis can be subdivided into spinal, intracranial and craniospinal pachymeningitis. In this study, we present a 21 years old woman with Tuberculosis pachymenegitis who had juvenile rheumatoid arthritis since infancy too. She developed headache and seizure 4 and 2 months ago respectively. Her headache became severe and she experienced 2 attacks of generalized tonic-clonic seizures. Dural biopsy showed neither rheumatoid nodules nor vasculitic process. Considering clinical features such as morning stiffness, arthralgia and joint tenderness and absence of clinical and laboratory evidences of infectious causes, MRI findings were most consistent with rheumatoid pachymeningitis. Based on clinical features, MRI, and laboratory test results, rheumatoid pachymeningitis was suspected for the patient and IV methylprednisolone was administered. Finally, this report emphasizes the importance of considering TB as one of the most common causes of pachymeningitis especially in the endemic area despite the existence of negative PCR and PPD tests. Copyright © 2019, SciTechnol, All Rights Reserved.