A non-permanent tonic pupil in rheumatoid arteritis

Area of Science:

• Rheumatology
• Ophthalmology
• Neurology

Background:

• Rheumatoid arthritis is a chronic autoimmune disease primarily affecting joints.
• Systemic vasculitis, including rheumatoid arteritis, can manifest in various organs.
• Ocular and neurological complications can arise from systemic inflammatory conditions.

Observation:

• A 76-year-old male presented with severe rheumatoid arthritis, polymyositis, eosinophilia, and episcleritis.
• The patient developed a transient tonic pupil, indicating a temporary dysfunction of the pupil's autonomic innervation.
• Muscle biopsy revealed occlusive arteritis with eosinophilic infiltration.

Findings:

• The constellation of symptoms and biopsy findings strongly suggest widespread rheumatoid arteritis.
• The arteritis is hypothesized to have caused a reversible ischemic insult to the ciliary ganglion.
• This ischemic event led to a transient denervation of the pupil, explaining the tonic pupil.

Implications:

• This case illustrates a rare neurological complication of rheumatoid arthritis.
• It underscores the importance of considering systemic vasculitis in patients with atypical neurological presentations.
• Early recognition and management of rheumatoid arteritis may prevent irreversible neurological damage.