Reversible Parkinsonism With Recovery of 123I-Ioflupane DAT‑SPECT After Treating Rheumatoid Meningitis

We report reversible parkinsonism in rheumatoid meningitis with normalization of 123 I-ioflupane DAT-SPECT after immunotherapy. A previously independent 42-year-old man presented with fever, encephalopathy, focal seizures, and akinetic-rigid parkinsonism. MRI showed pachy/leptomeningeal enhancement with sulcal FLAIR hyperintensity; CSF revealed lymphocytic pleocytosis and elevated protein with negative infectious studies. High-dose intravenous methylprednisolone followed by taper led to rapid improvement. Baseline DAT-SPECT showed reduced striatal uptake, which recovered on follow-up in parallel with symptom resolution and reductions in intrathecal anti-CCP index and CSF IL-6, supporting autoimmune, reversible presynaptic dopaminergic dysfunction.