BACKGROUNDGranulomatosis with polyangiitis (GPA) is a form of vasculitis associated with antineutrophil cytoplasmic antibodies, characterized by granulomatous inflammation and varied degrees of focal necrotizing vasculitis, affecting medium and small blood vessels. This disease has a tropism to the respiratory tract and kidneys. Among the neurological manifestations, peripheral neuropathy is the most common type of neurological involvement and central nervous system involvement has been reported in 7-11% of patients. We report a case of GPA in a patient with neurological symptoms and pachymeningeal thickening. CASE REPORTA 46-year-old female patient sought the Emergency Department due to two episodes of seizures, being hospitalized for investigation. Patient had been using hydroxychloroquine 400 mg daily for 1 year due to a history of bilateral parotitis, arthralgias, purpuric dermatitis, reagent ANA and reagent anti-SSA(Ro). Magnetic resonance imaging demonstrated an area of gadoliniumenhancing nodular thickening of the pachymeningeal lining in the left temporo-occipital transition, with a thickness of 0.6 cm, and vasogenic edema in the white matter of the adjacent parenchyma. She had elevated acute phase reagents, c-ANCA reagent up to 1/20, nonreactive antiproteinase-3 and antimyeloperoxidase. The biopsy of the meningeal lesion showed chronic inflammation with palisade granuloma and central necrosis, favoring the diagnosis of granulomatosis with polyangiitis involving the central nervous system. The patient was discharged from the hospital asymptomatic and on high-dose prednisone, with an outpatient plan to start immunosuppressants. CONCLUSIONWe report a case of granulomatosis with polyangiitis presenting central nervous system evidenced by imaging exam, an uncommon form of manifestation of this condition.

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BACKGROUNDThere is an evident lack of Personal Finance knowledge among physicians from all over the world. In Brazil, Personal Finance was recently included at the National Base Common Curriculum and it is slowly gaining some spotlights at the media, but not in medical school curriculum or residency programs. In fact, physicians could be one of the worst savers and budgeters in the working population in some countries as United States of America. During the resident years, medical fellows are subjected to a 60-h-week study and work programs, receiving a low income of residency's grants-a payment much below the floor established by the medical category, which brings difficulties those physicians. Besides this, after graduation, many students from private medical schools have a huge student loan debt and need to complement the incomes working even more during their residency programs to compensate their loans. METHODSThis literature review used PubMed and SciELO databases, included the keywords "personal finances," "economic," "debt," "student loans," matching with "rheumatologist," "rheumatologist student," "medical resident," "resident," "medical student," "student," in English, Portuguese and Spanish languages. RESULTSThere are not studies evaluating Personal Finance knowledge or personal finance educational projects among Brazilian's medical or rheumatology residents, not even rheumatology residents worldwide. Although this gap of knowledge, there are some data obtained from groups of physical medicine and rehabilitation, emergency medicine, pediatric, plastic surgery, internal medicine and surgery residents analyzing this subject. In all studies available there was an evident lack of knowledge about basic personal finance in these groups, but the majority of the trainees wanted to learn more about this topic, and when this education was provided, their well-being improved not just in the personal finance specter, as in mental and emotional circles. In the other hand, medical residents with poor financial knowledge and/or with financial debts were associated with increased risk of stress, depression and burnout syndrome. CONCLUSIONPersonal Finance must be discussed in the formation of the rheumatologist's residents at residence programs as soon as possible. Learning to deal with shortage of financial power, as school debts and many other possible debts, and looking forward to a better retirement plan since the early career can provide a better life quality to trainees and prevent mismanagements that could create devastating effects in short and long term on financial and psychosocial health.

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