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A 62 year old man had RA for five years that had been diagnosed according to the 1987 American Rheumatic Association criteria. His disease was well controlled with disease modifying antirheumatic agents (DMARDs). However, the DMARDs were discontinued in March 2000, and he entered a leflunomide clinical trial from April 2000 to August 2000. He improved during the trial. After the trial ended and the leflunomide was discontinued, his joint pain and swelling resumed, so DMARDs were started again.
In December 2000, he arrived in our emergency department with the sudden onset of a disturbance of consciousness, fever, chills, throbbing headache, and left limb weakness for a few days. On physical examination, his temperature was 38.3°C, and he had slurred speech, …
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