Diffuse intracranial meningeal enhancement in Wegener's granulomatosis-A rare finding

Wegener's granulomatosis is characterized by necrotizing granulomatosis and glomerulonephritis. In addition to this classic triad, vasculitis or granuloma, or both, can affect virtually any organ. Meningeal involvement in Wegener's granulomatosis is very rare, and there have only been 46 cases reported in literature. We present a case of a 35-year-old man who was diagnosed with Wegener's granulomatosis due to his clinical presentation of chronic sinusitis, digital gangrene secondary to vasculitis and laboratory results. He later presented with decreased vision in the right eye, headache and vomiting. On further examination he was found to have retrobulbar neuritis and cranial nerve palsy. An MRI revealed the presence of meningeal enhancement and after treatment with rituximab (monoclonal antibody) the patient's symptoms resolved.