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Washington University Experience | MISCELLANEOUS | Rheumatoid Nodule - Pachymeningitis - Odontoid subluxation | 1A1 Rheumatoid Nodules (Case 1) 1

Although the histologic appearance in this case is not inconsistent with infection, no organism was identified, either by culture of tissue obtained at the time of surgery, or by special histologic methods [bacteria (Gram), fungi (GMS), acid fast bacilli (Ziehl-Nielsen, Fite), spirochetes (Warthin-Starry, Steiner)] repeated several times. Considering the patient's history of rheumatoid arthritis and cutaneous rheumatoid nodules, we favor that it represents a meningeal rheumatoid nodule. This intraoperative image shows a largely leptomeningeal process which closely resembles purulent meningitis.

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