He was thought to have lymphocytic
leptomeningitis. Serum and CSF angiotensinconverting enzymes (ACE) were normal.
(i) Methotrexate (MTX) can cause rheumatoid nodulosis on the extremities as well as
leptomeningitis, probably through induction of adenosine synthesis [1].
MRI dorsolumbar spine showed leptomeningeal enhancement suggestive of spinal
leptomeningitis and arachnoiditis.
The symptoms of acute syphilitic
leptomeningitis are observed usually within the first year, especially in the first 3-6 months.
Casey, "Acute purulent
leptomeningitis mimicking subarachnoid hemorrhage on ct," Journal of Computer Assisted Tomography, vol.
Autopsy findings included extensive white matter necrosis of the temporal lobes, haemorrhagic infarction of temporal and occipital lobes,
leptomeningitis in sections of the parietal cortex, and haemorrhagic necrosis of the cerebellum.
Over the course of the following 12 months, he suffered from uveitis, thrombocytopenia, and 2 more acute episodes of fever, headache, and photophobia and developed a lymphocyte-predominant cerebrospinal fluid (CSF) pleocytosis, as well as biopsy-proven granulomatous
leptomeningitis. All routine tests for infectious disease agents were negative.
Histopathological changes consistent with acute neurologic Lyme disease, showing
leptomeningitis and radiculitis, as well as satellite glial cell and neuronal apoptosis in the DRG were also observed.
Carcinomatous
leptomeningitis in small cell lung cancer: A clinicopathologic review of the National Cancer Institute experience.