Rheumatoid cranial pachymeningitis successfully treated with long-term corticosteroid.

We report a 68-year-old man without clinical history of rheumatoid arthritis who presented with acute bilateral palsy of the IX and X cranial nerves secondary to pachymeningitis confirmed on cranial MRI. Rheumatoid factor in both serum and cerebrospinal fluid and anti-agalactosyl IgG antibody in serum were positive. The radiographs of hands and feet revealed signs of early rheumatism. The dural biopsy specimen showed chronic inflammation with infiltration of lymphocytes and histiocytes. A diagnosis of rheumatoid cranial pachymeningitis was made. Treatment with long-term corticosteroid was excellently effective.