[A case of malignant rheumatoid arthritis with transverse myelopathy and multiple lacunar infarction]

We reported a 34-year-old woman with malignant rheumatoid arthritis (MRA) associated with transverse myelopathy and multiple lacunar infarction. She had suffered from MRA for 9 years, then developed sensory disturbance of left big toe and weakness of right lower limb. Neurological examination revealed the muscle weakness of right lower limb. Deep tendon reflexes were hyperactive in bilateral lower limbs. Babinski's sign was positive bilaterally. Superficial sensation was decreased below Th10 level on the left side. Urinary bladder and rectal disturbance were not present. Laboratory examination disclosed perinuclear antineutrophil cytoplasmic autoantibody (p-ANCA) and anti-nuclear antibody (ANA). Multiple lacunar infarction and syringomyelia were found by MRI studies. Histological examinations of skin ulcer biopsied at 17 years of age disclosed vasculitis. We speculated that vasculitis associated with MRA might cause the damage of central nervous system (CNS) in our case. The p-ANCA may accelerate the vasculitic changes in CNS.