Table of Contents
ISRN Rheumatology
Volume 2011, Article ID 608942, 4 pages
Case Report

Wegener's Granulomatosis Presenting with Pachymeningitis: Clinical and Imaging Remission by Rituximab

1Department of Internal Medicine, Odense University Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark
2Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark
3Department of Radiology, Odense University Hospital, 5000 Odense, Denmark

Received 23 March 2011; Accepted 12 April 2011

Academic Editors: J. K. Dawson, S. Morimoto, and A. Schattner

Copyright © 2011 Søren Andreas Just et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A 27-year-old woman was admitted for intractable right-sided neck, ear, and jaw pain with gradual development of tinnitus and hearing loss. A cerebral MRI showed meningo-dural enhancement, and additional diagnostic workup revealed a right pulmonary infiltrate and positive PR-3 ANCA. Biopsies from nasal mucosa and lung showed chronic inflammation with granuloma formation. Based on these findings the patient was diagnosed with Wegener's granulomatosis with pachymeningitis. There was no clinical response to oral Prednisolone and Cyclophosphamide, but complete clinical and imaging remission was achieved by adding Rituximab.