Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2013 Jul;16(3):411-3.
doi: 10.4103/0972-2327.116920.

Chronic meningitis with multiple cranial neuropathies: A rare initial presentation of Wegener's granulomatosis

Vikas Gupta  1 , Anjani Kumar Sharma, Rajendra Kumar Sureka, Sushant Kumar Bhuyan, Prashant Kumar Singh
Affiliations
Case Reports

Chronic meningitis with multiple cranial neuropathies: A rare initial presentation of Wegener's granulomatosis

Vikas Gupta et al. Ann Indian Acad Neurol. 2013 Jul.

Abstract

Wegener's granulomatosis (WG) is a systemic necrotizing vasculitis that affects the small blood vessels. It mainly affects the upper and lower respiratory tract and kidneys. Central nervous system (CNS) involvement is rare, and has been reported only in about 8% of cases during the course of illness. Initial presentation with neurologic affection, particularly chronic hypertrophic meningitis is very unusual. We report the case of a 34 year old male who presented with chronic hypertrophic meningitis and multiple cranial nerve involvement as the initial manifestation, without respiratory and renal symptoms. This case highlights the difficulties in diagnosing a rare disease with rarer presentation, and at the same time illustrates that Wegener's granulomatosis should be considered in the differential diagnosis of chronic meningitis.

Keywords: Chronic meningitis; Wegener's granulomatosis; cranial neuropathies.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Magnetic resonance imaging brain of the patient in the study showing dural thickening and abnormal enhancement
Figure 2
Figure 2
Computed Tomography scan of the thorax of the patient in the study showing multiple cavitating nodular opacities in right lung field
Figure 3
Figure 3
Non Contrast Computed Tomography scan of the temporal bone of the patient in the study showing bilateral opaque mastoid air cells and tympanic cavities
Figure 4
Figure 4
Non Contrast Computed Tomographyscan the paranasal sinuses of the patient in the study showing chronic rhino-sinusitis
Figure 5
Figure 5
Nasopharyngeal biopsy of the patient in the study showing chronic granulomatous inflammation
See this image and copyright information in PMC

References

    1. Langford CA, Fauci AS. Harrison's Principles of Internal Medicine. 17th ed. Vol. 2. New York: The McGraw-Hill Companies, Inc; 2008. The Vasculitis Syndromes; pp. 2121–4.
    1. Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, et al. Wegener granulomatosis: An analysis of 158 patients. Ann Intern Med. 1992;116:488–98. - PubMed
    1. Dörr J, Elitok S, Dieste FJ, Vogel HP, Schneider W, Wuerfel J, et al. Treatment-resistant chronic headaches and focal pachymeningitis in a 46-year-old man: A rare presentation of Wegener's granulomatosis. Lancet Neurol. 2008;7:368–72. - PubMed
    1. Jinnah HA, Dixon A, Brat DJ, Hellmann DB. Chronic meningitis with cranial neuropathies in Wegener's granulomatosis. Case report and review of the literature. Arthritis Rheum. 1997;40:573–7. - PubMed
    1. Shobha N, Mahadevan A, Taly AB, Sinha S, Srikanth SG, Satish S, et al. Hypertrophic cranial pachymeningitis in countries endemic for tuberculosis: Diagnostic and therapeutic dilemmas. J Clin Neurosci. 2008;15:418–27. - PubMed

Publication types