To describe a rare case of rheumatoid leptomeningitis (RLM) and emphasize the diagnostic and therapeutic challenges of this uncommon central nervous system manifestation of rheumatoid arthritis (RA).

Rheumatoid arthritis is a chronic systemic autoimmune disease affecting approximately 0.5–1% of the population, frequently associated with extra-articular involvement. Central nervous system manifestations are rare, with rheumatoid leptomeningitis representing an exceptionally uncommon and often underrecognized complication. RLM can occur in patients with long-standing, well-controlled, or minimally active RA and presents with highly variable, nonspecific neurologic symptoms including seizures, headache, encephalopathy, and focal deficits. Neuroimaging and cerebrospinal fluid (CSF) findings are often suggestive but nonspecific, complicating diagnosis. Due to its rarity, absence of standardized diagnostic criteria, and overlap with infectious, malignant, and other autoimmune etiologies, diagnosis is frequently delayed, and management relies largely on case-based experience.

This case highlights rheumatoid leptomeningitis as a rare but important neurologic complication of RA. Early recognition, exclusion of alternative etiologies, and prompt initiation of immunosuppressive therapy are critical to improving outcomes. Increased awareness and reporting are essential to advancing diagnostic strategies and optimizing management for this potentially treatable condition.