title: Case of refractory otitis media with high-titer positive serum MPO-ANCA value.
abstract: A 56-year-old-woman presented a local otolaryngologist with a complaint of hearing loss. She was treated with antibiotics as acute otitis media, however her symptom did not improved. She admitted to our hospital because of hearing loss on both sides, fever, otorrhea and vertigo. On admission, an audiogram showed bilateral mixed conductive-sensorineural hearing loss, and CT image revealed the exudates in bilateral middle ear cavities and mastoid air cells. Moreover, serum level of myeloperoxidase anti-neutrophil cytoplasmic autoantibody (MPO-ANCA) elevated (133EU). Although pulmonary, renal and cutaneous involvements were not noted and the histopathological examination of operated specimen taken from otitis media revealed non-specific inflammatory changes, in the absence of any other obvious causes of otitis media, these findings might be associated with positive serum MPO-ANCA value itself. After the initiation of therapy with methylprednisolone and azathioprine, her symptoms and hearing ability ameliorated and both CRP value and the titer of ANCA became normalized. But, after the improvement by the immunosuppressive treatment, MRSA in the otorrhea persisted. This case suggests that otitis media may be one of the symptoms of vasculitis, and some previous cases described otitis media or hearing loss as rare manifestations of vasculitis. It is important to make an early diagnosis for good prognosis of hearing ability, and we have to consider the differential diagnosis including of ANCA-related vasculitis.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine.
authors.forename: Naoto
authors.initials: N
authors.lastname: Azuma
authors.forename: Chieri
authors.initials: C
authors.lastname: Kanda
authors.forename: Aki
authors.initials: A
authors.lastname: Nishioka
authors.forename: Junpei
authors.initials: J
authors.lastname: Tanaka
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Mishiro
authors.forename: Jyuri
authors.initials: J
authors.lastname: Takehara
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sawada
authors.forename: Masayasu
authors.initials: M
authors.lastname: Kitano
authors.forename: Mika
authors.initials: M
authors.lastname: Okabe
authors.forename: Mai
authors.initials: M
authors.lastname: Morimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sekiguchi
authors.forename: Takanori
authors.initials: T
authors.lastname: Kuroiwa
authors.forename: Naoaki
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsui
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Sano
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000175:diagnosis*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001379:Azathioprine / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D034381:Hearing Loss / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000188:drug therapy* / Q000209:etiology*; D009195:Peroxidase / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D009195:Peroxidase; D001379:Azathioprine; D008775:Methylprednisolone