A Case of Central Nervous System Vasculitis Secondary to Rheumatoid Arthritis Treated Successfully with Mycophenolate.

Here we report a case of central nervous system vasculitis (CNSV) in rheumatoid arthritis (RA) treated successfully with corticosteroid and mycophenolate. A 53-year-old female with poorly controlled RA presented with unilateral lower motor neurone type 7th cranial nerve palsy. MRI of brain revealed bilateral signal intensity changes in posterior fossa, basal ganglia, periventricular white matter with contrast enhancement. Rheumatoid factor, anti-CCP and C-reactive protein were high. Cerebrospinal fluid analysis showed pleocytosis with elevated protein. Digital subtraction angiography of brain revealed beading pattern in distal branches of anterior, middle and posterior cerebral arteries bilaterally suggestive of central nervous system vasculitis. We treated the patient with Intravenous methyl prednisolone followed by oral prednisolone tapered off in 6 months. Mycophenolate mofetil was started at the dose of 2g per day, along with prednisolone. Sulfasalazine and hydroxychloroquine were also started to treat her arthritis. Patient showed complete neurological improvement, along with significant resolution of the lesions in MRI.