Rheumatoid variable vessel vasculitis concurrently affecting small, medium and large vessels

Rheumatoid vasculitis (RV) is a rare and severe extra-articular complication of rheumatoid arthritis (RA), typically occurring in patients with longstanding and erosive RA. It most commonly involves small and medium sized vessels, but it can also affect large vessels. In this case report, we present a patient with de novo RV who developed multisystem vasculitis that affected small, medium and large vessels prior to the diagnosis of RA. The patient had markedly elevated rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, confirming the diagnosis of RV. This case highlights the challenge of diagnosing RV in the absence of prior RA.