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Washington University Experience | MISCELLANEOUS | Rheumatoid Nodule - Pachymeningitis - Odontoid subluxation | 5A0 Case 5 History
Case 5 History ---- The history in this patient was unremarkable until three years before his death when joint pain and swelling necessitated NSAIDs followed by steroid therapy one year antemortem. He presented 2 months antemortem with a 6 month history of progressive general malaise, anorexia, dyspnea on exertion and a 60 pound weight loss. A chest x-ray revealed a poorly-defined nodular density in the lateral right upper lung lobe. Repeat ECG showed second degree AV block treated with placement of a pacemaker. An echocardiogram showed fused, thickened aortic valve cusps and a moderate to large pericardial effusion. He subsequently had a fatal cardiorespiratory arrest.
This patient had no clinical signs or symptoms of neurologic disease throughout his course. The brain weighed 1430 gm. The cerebral dura and falx cerebri were thickened and had focal nodularity. There was diffuse, firm, homogeneous, yellow-white thickening of the leptomeninges along the medial surfaces of the cerebral cortex adjacent to the falx. Rheumatoid factor was elevated and no organisms were found.
