A 49-year-old female was suffering from RA since 2004. Initially, the patient received SASP and BUC. However, therapy was switched to MTX in 2007 due to insufficient efficacy. In 2009, ETN was administered without chest X-ray and TST examinations by a previous clinic doctor and was effective against RA. In October 2009, the patient visited National Sagamihara hospital and had fever (>38 C), headache, and general malaise. Although ETN was discontinued and PSL (10 mg/day) was administered, the fever persisted, the headache worsened, and vomiting was reported. The patient was admitted to the National Sagamihara Hospital in December 2009. Body temperature was approximately 40 C without manifestations on physical examinations. The levels of serum CRP were approximately 1 mg/dl, and the levels of neutrophil CD64 were highly elevated (up to 11,387 molecules/cell) (Figure 5). TST was negative, and head CT scan images showed no abnormalities. A lumbar puncture revealed slightly turbid cerebrospinal fluid (CSF) with 344 white blood cells/mul (88% lymphocytes and 12% polymorphs) and low levels of glucose (29.9 mg/dl in CSF vs. 116 mg/dl) in blood. Assessment for cryptococcal antigen in the CSF was negative. Acid-fast bacteria were not detected in smear preparations from CSF and gastric juice. The following day after admission, the patient's conscious level worsened. Gd-DTPA-enhanced magnetic resonance imaging (MRI) of the brain was performed. A pia-subarachnoid enhancement was found on the fluid-attenuated inversion recovery (FLAIR) sequence, which was compatible with meningitis (Figure 6). Initially, acyclovir was administered; however, the fever and level of consciousness were not improved. A lumbar puncture was performed again four days later and acid-fast bacteria were not found in the smear preparation. PCR of CSF for Mycobacterium tuberculosis was positive. The patient was diagnosed with tuberculous meningitis and transferred to a university hospital. Combination therapy of INH, rifampicin, and ethambutol resulted in gradual improvement of the level of consciousness. Six weeks later, positive results for Mycobacterium tuberculosis of cultures of gastric juice and CSF were reported. The levels of neutrophil CD64 decreased below the cutoff value after completion of anti-TB therapy.