Intracranial rheumatoid nodule causing recurrent transient neurological deficits

Abstract

A 67-year-old man with rheumatoid arthritis developed recurrent acute onset of stereotyped focal neurological abnormalities. Cerebral imaging showed a mass lesion in the left parieto-occipital lobe. Imaging did not show the time evolution expected in stroke and so he underwent an extensive workup, which was inconclusive. Brain biopsy identified a rheumatoid nodule causing an extensive inflammatory reaction that mimicked a mass. Following treatment with intravenous corticosteroids and rituximab infusions, his clinical condition improved. While rheumatoid meningitis is well recognised, a rheumatoid nodule in the brain rarely presents as a mass lesion. Neverthelessrheumatoid nodule in the differential diagnosis of a cerebral mass lesion in patients with rheumatoid arthritis.

Neurologic Manifestations of Rheumatologic Disorders

“…In a review of cases of CNS rheumatoid vasculitis, most patients in whom testing results were reported had elevations in serum biomarkers of RA 20 . Rheumatoid nodules can be seen on pathological examination of the biopsies of patients ultimately diagnosed with rheumatoid meningitis or CNS vasculitis but have also been reported to occur as mass lesions in the parenchyma 21,22 . Rheumatoid nodules presenting as isolated mass lesions are exceedingly uncommon.…”