Aseptic Meningitis-retention Syndrome Associated with Tocilizumab in a Patient with Idiopathic Multicentric Castleman Disease

Akira Arakawa; Masaki Iizuka; Shunichi Matsuda; Erika Matsubara; Hiroki Yamazaki; Noritada Yoshikawa; Hirotoshi Tanaka; Toshihiro Yoshizawa

doi:10.2169/internalmedicine.6938-20

CASE REPORTS

Aseptic Meningitis-retention Syndrome Associated with Tocilizumab in a Patient with Idiopathic Multicentric Castleman Disease

Akira Arakawa, Masaki Iizuka, Shunichi Matsuda, Erika Matsubara, Hiroki Yamazaki, Noritada Yoshikawa, Hirotoshi Tanaka, Toshihiro Yoshizawa

Author information

Akira Arakawa
Department of Neurology, NTT Medical Center Tokyo, Japan
Masaki Iizuka
Department of Neurology, NTT Medical Center Tokyo, Japan
Shunichi Matsuda
Department of Neurology, NTT Medical Center Tokyo, Japan
Erika Matsubara
Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Hiroki Yamazaki
Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Noritada Yoshikawa
Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Hirotoshi Tanaka
Department of Rheumatology and Allergy, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Japan
Toshihiro Yoshizawa
Department of Neurology, NTT Medical Center Tokyo, Japan

Keywords: aseptic meningitis, meningitis-retention syndrome, tocilizumab, idiopathic multicentric Castleman disease

JOURNAL OPEN ACCESS

2021 Volume 60 Issue 24 Pages 3995-3998

DOI https://doi.org/10.2169/internalmedicine.6938-20

Browse “Advance online publication” version

Details

Abstract

This is the first report of tocilizumab-associated meningitis-retention syndrome in a patient with idiopathic multicentric Castleman disease. A 57-year-old man presented with headache, nuchal rigidity, impaired consciousness, pyramidal tract signs and urinary retention. A cerebrospinal fluid examination revealed increased cell counts and protein levels. These symptoms were improved by intravenous methylprednisolone. Tocilizumab-associated meningoencephalitis has been reported in patients with rheumatoid arthritis and juvenile idiopathic arthritis but not with multicentric Castleman disease. This case presents evidence of the increased probability of meningitis as a neurological complication of tocilizumab administration.

Corresponding author

Register with J-STAGE for free!