Cervical Stenosis in the Setting of ANCA-Associated Vasculitis: An Opportunity to Discuss Hypertrophic Pachymeningitis as a Medically Treatable Etiology of Cervical Spinal Cord Compression

We report the case of a 56-year-old woman with a history of anti-neutrophil cytoplasmic antibodies-associated vasculitis who presented with progressive gait imbalance and hand clumsiness following discontinuation of methotrexate. Magnetic resonance imaging demonstrated circumferential epidural/dural soft tissue thickening extending from the posterior fossa into the upper cervical spine, consistent with hypertrophic pachymeningitis. The lesion produced severe cervical spinal cord compression; however, on two separate occasions, reinitiation of methotrexate and corticosteroids resulted in marked clinical and radiographic improvement. Accordingly, this case report describes a relatively uncommon driver of cervical spinal cord compression and emphasizes the importance of considering medically treatable etiologies in select patients presenting with apparent cervical stenosis.