CLIPPERS: Induction and maintenance of remission using hydroxychloroquine

Chronic lymphocytic inflammation and pontine perivascular enhancement responsive to steroids (CLIPPERS) is a condition that was first described by Pittock et al. in 2010 and is characterized by brainstem symptoms, gait ataxia, and diplopia. Brain MRIs of patients demonstrate punctate or nodular gadolinium-enhancing lesions in the pons. CLIPPERS is a diagnosis of exclusion through laboratory, radiologic, or histologic tests. Most patients to date have been treated with steroids, with some eventually switching to other immunosuppressants with variable and significant side effect profiles. We describe a patient with CLIPPERS in whom treatment with hydroxychloroquine was successful in inducing and maintaining the remission of symptoms confirmed by radiologic resolution.