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[A case of malignant rheumatoid arthritis with lupus anticoagulant and cerebral infarction]
E Maeshima1, M Sakagashira, Y Yamada
1Third Department of Internal Medicine, Wakayama Medical College, Japan.
Abstract:
We reported a case of malignant rheumatoid arthritis (MRA) with cerebral infarction associated with a possible cause of lupus anticoagulant. The patient was a 68-year-old woman who had received treatment for rheumatoid arthritis (RA) from 15 to 16 years ago. She consulted to our hospital with a major complaint of right hemiplegia. Brain CT revealed a low density area in the left hemisphere. She was diagnosed as cerebral infarction and hospitalized. Since she was noted to have hypocomplementemia, interstitial pneumonia and pericarditis, she was diagnosed as MRA. Coagulation test disclosed positive lupus anticoagulant (LA). Generally, CNS disorders in MRA are uncommon. Cerebral infarction was complicated in the present case, suggesting the involvement of antiphospholipid antibodies as its pathogenesis.
Insights
This case report details a 68-year-old woman with malignant rheumatoid arthritis (MRA) who experienced a cerebral infarction. Lupus anticoagulant was identified as a potential cause, highlighting a rare central nervous system complication in MRA.
Area of Science:
- Rheumatology
- Neurology
- Hematology
Background:
- Malignant rheumatoid arthritis (MRA) is a severe form of rheumatoid arthritis (RA).
- Central nervous system (CNS) complications are infrequent in MRA patients.
- Antiphospholipid antibodies are implicated in thrombotic events.
Observation:
- A 68-year-old female patient with a history of RA presented with right hemiplegia.
- Brain CT confirmed cerebral infarction.
- The patient exhibited hypocomplementemia, interstitial pneumonia, and pericarditis, leading to an MRA diagnosis.
Findings:
- Coagulation tests revealed a positive lupus anticoagulant (LA).
- The patient was diagnosed with MRA complicated by cerebral infarction.
- This suggests antiphospholipid antibodies may play a role in CNS involvement in MRA.
Implications:
- This case underscores the importance of considering thrombotic events in MRA patients, even with rare CNS manifestations.
- Identifying lupus anticoagulant is crucial for managing MRA patients at risk of stroke.
- Further research into the pathogenesis of CNS complications in MRA is warranted.