Relapsing polychondritis and lymphocytic meningitis with varied neurological symptoms

Abstract

Background: Relapsing polychondritis is a rheumatological disease characterized by bilateral auricular chondritis, vestibular compromise and varied neurological symptoms. Objective: To report the case of a patient with relapsing polychondritis and several neurological manifestations. Patient and method: We report the case of a patient with relapsing polychondritis with several neurological manifestations. Results: A 69 year-old male was admitted with a 20-day history of ataxia, paraparesis, tinnitus, vertigo and confusion. Two months before he started with bilateral auricular chondritis and arthritis of metacarpophalangeal joints and ankles. He had been previously seen at another hospital,where he had been treated for herpetic encephalitis, with improvement of confusion. On examination he had downward nistagmus, rigidity of upper limbs, paraparesis, absent reflexes, tactile hypoesthesia, dismetric movements, gross postural and action tremor, bradikynesia and truncal ataxia. He also had swelling and a purplish erythema of both ear lobes and arthritis in the metacarpophalangeal joints of the right hand. Brain and cervical MRI disclosed a mild thickening of the dura. A new lumbar puncture confirmed the presence of elevated leukocytes and laboratory exams disclosed augmented inflammatory activity. A diagnosis of relapsing polychondritis was made based on the association of chondritis, arthritis and vestibular ataxia with predominant neurological symptoms. Following a course of Prednisone 1 mg/kg qid there was major improvement of chondritis, arthritis, ataxia and paraparesis, but the tremor remained unchanged. Conclusion: Relapsing polychondritis is a multisystemic disease that can manifest not only with bilateral auricular chondritis and vestibular compromise, but also with varied neurological symptoms.