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

• Published in: Internal Medicine Vol. 60; no. 24; pp. 3995 - 3998
• Main Authors: Arakawa, Akira, Iizuka, Masaki, Matsuda, Shunichi, Matsubara, Erika, Yamazaki, Hiroki, Yoshikawa, Noritada, Tanaka, Hirotoshi, Yoshizawa, Toshihiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.12.2021; Japan Science and Technology Agency
• Subjects: Antibodies, Monoclonal, Humanized - adverse effects; Arthritis; Aseptic meningitis; Case Report; Castleman Disease - complications; Castleman Disease - drug therapy; Castleman's disease; Cerebrospinal fluid; Humans; idiopathic multicentric Castleman disease; Internal medicine; Intravenous administration; Male; Meningitis; Meningitis, Aseptic - chemically induced; Meningitis, Aseptic - diagnosis; Meningitis, Aseptic - drug therapy; meningitis-retention syndrome; Meningoencephalitis; Methylprednisolone; Methylprednisolone - therapeutic use; Middle Aged; Neurological complications; Retention; Rheumatoid arthritis; tocilizumab; idiopathic multicentric Castleman disease; tocilizumab; aseptic meningitis; meningitis-retention syndrome
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.6938-20

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.