Effective Response of Methotrexate for Recurrent Idiopathic Hypertrophic Spinal Pachymeningitis

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic progressive and diffuse inflammatory fibrosis of the spinal dura mater. Though treatment of IHSP is surgical decompression with steroid therapy, treatment for recurrent IHSP is controversial. Our patient was diagnosed with IHSP based on magnetic resonance imaging (MRI) and underwent laminectomy for decompression following steroid pulse therapy. Despite maintenance of steroid therapy, the patient experienced 3 recurrences. As an alternative immunosuppressant medication, methotrexate was introduced with low-dose steroid. Fortunately, the symptom was resolved, and a decrease of dura thickening was revealed on MRI. We present the case and suggest that methotrexate might be an effective treatment modality for recurrent IHSP.

[1]  Zhi Hu,et al.  Idiopathic hypertrophic spinal pachymeningitis: a case report and review of literature , 2015, European Spine Journal.

[2]  P. Busson,et al.  Idiopathic hypertrophic pachymeningitis presenting with occipital neuralgia. , 2015, African Health Sciences.

[3]  A. Coombes,et al.  Idiopathic hypertrophic cranial pachymeningitis presenting as acute painless visual loss , 2012, International Ophthalmology.

[4]  Tomoatsu Kimura,et al.  Long-term outcome of idiopathic hypertrophic thoracic pachymeningitis , 2012, European Spine Journal.

[5]  J. Sheehan,et al.  Idiopathic hypertrophic spinal pachymeningitis. , 2011, Journal of neurosurgery. Spine.

[6]  Keun-Tae Cho,et al.  Idiopathic Hypertrophic Cranial Pachymeningitis Presenting With Headache , 2008, Headache.

[7]  L. Defebvre,et al.  Idiopathic hypertrophic cranial pachymeningitis treated by oral methotrexate: a case report and review of literature , 2007, Rheumatology International.

[8]  Y. Matsuyama,et al.  Recurrence of hypertrophic spinal pachymeningitis. Report of two cases and review of the literature. , 2006, Journal of neurosurgery. Spine.

[9]  S. Gutierrez-Ureña,et al.  Idiopathic hypertrophic cranial pachymeningitis successfully treated with weekly subcutaneous methotrexate , 2006, Acta Neurochirurgica.

[10]  M. Kupersmith,et al.  Idiopathic hypertrophic pachymeningitis , 2004, Neurology.

[11]  C. Lui,et al.  Idiopathic hypertrophic cranial pachymeningitis: case report with 7 years of imaging follow-up. , 2003, AJNR. American journal of neuroradiology.

[12]  P. Cherian,et al.  Idiopathic hypertrophic cranial pachymeningitis. , 2002, Neurology India.

[13]  R. Sevick,et al.  Idiopathic Hypertrophic Pachymeningitis: A Report of Two Patients and Review of the Literature , 2000, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[14]  F. Iwamoto,et al.  Idiopathic cranial pachymeningoencephalitis focally affecting the parietal dura mater and adjacent brain parenchyma: case report. , 1997, Neurosurgery.

[15]  F. Umansky,et al.  Hypertrophic spinal pachymeningitis: report of two cases and review of the literature. , 1991, Neurosurgery.

[16]  C. Marsault,et al.  Hypertrophic cranial pachymeningitis: assessment with CT and MR imaging. , 1989, AJNR. American journal of neuroradiology.

[17]  Bucy Pc,et al.  Hypertrophic spinal pachymeningitis with special reference to appropriate surgical treatment. , 1952 .

[18]  P. Bucy,et al.  Hypertrophic spinal pachymeningitis with special reference to appropriate surgical treatment. , 1952, Journal of Neurosurgery.

[19]  W. E. Stern,et al.  Chronic pachymeningitis; report of a case and review of the literature. , 1949, Archives of neurology and psychiatry.

[20]  Jm Charcot,et al.  Deux cas d’atrophie musculaire progressive avec lesions de la substance grise et des faisceaux antero-lateraux de la moelle epiniere , 1869 .