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CASE REPORT
A 51 year old woman with a 34 year history of seropositive, erosive, nodular rheumatoid arthritis (RA) complained of non-specific headache and diplopia of insidious onset at a routine appointment with her ophthalmologist. Her RA was generally well controlled with sulfasalazine 2 g daily, which she had taken for four years. Other drugs were bendrofluazide 2.5 mg and atenolol 50 mg daily for hypertension along with hypromellose eye drops for dry eyes. She had no other medical history of note. She had previously been treated with intramuscular gold from 1977 until 1985 and with auranofin from 1987 until 1996.
Physical examination showed weakness of the right medial, lateral, and superior recti. The most likely cause was thought to be ocular nerve palsy, but a magnetic resonance (MR) scan of …