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Case report
Meningeal rheumatoid nodules in a 55-year-old man presenting with chronic headaches and oculomotor nerve palsy: an uncommon extra-articular manifestation of rheumatoid arthritis
  1. Hafez Mohammad Ammar Abdullah1,
  2. Muhammad Omar2,
  3. Aiham Jbeli2 and
  4. Joseph Fanciullo3
  1. 1 Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
  2. 2 Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA
  3. 3 Rheumatology, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA
  1. Correspondence to Dr Hafez Mohammad Ammar Abdullah; ammar.abdullah{at}usd.edu

Abstract

Rheumatoid arthritis (RA) is a multisystem inflammatory disease which can involve many organ systems including the central nervous system (CNS). Though not very common, the results can be severely debilitating. The spectrum of the CNS involvement includes meningitis, encephalitis and occasionally rheumatoid nodules. Its presentation is variable, though very rarely it can present as focal neurological deficits. Imaging can be suggestive, but diagnosis usually requires tissue biopsy. Treatment consists of high-dose steroids and immunosuppressants. We describe the case of a 55-year-old male patient with a history of RA presenting with a third nerve palsy and headache who was found to have rheumatoid nodules on biopsy. CNS involvement in RA should be considered in anyone with rheumatoid arthritis who presents with focal neurological deficits, though infections and space-occupying lesions should also be ruled out.

  • cranial nerves
  • neuroimaging
  • rheumatoid arthritis
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Footnotes

  • Contributors HMAA and JF were responsible for writing the discussion and background. AJ and MO were responsible for the case presentation and summary.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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