Case of refractory otitis media with high-titer positive serum MPO-ANCA value.
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.
Azuma
Naoto
N
Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine.
Kanda
Chieri
C
Nishioka
Aki
A
Tanaka
Junpei
J
Mishiro
Yasuo
Y
Takehara
Jyuri
J
Sawada
Hisashi
H
Kitano
Masayasu
M
Okabe
Mika
M
Morimoto
Mai
M
Sekiguchi
Masahiro
M
Kuroiwa
Takanori
T
Hashimoto
Naoaki
N
Matsui
Kiyoshi
K
Iwasaki
Tsuyoshi
T
Sano
Hajime
H
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
D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D009195:Peroxidase; D001379:Azathioprine; D008775:Methylprednisolone