title: A case of MPO-ANCA-positive polyarteritis nodosa complicated by exudative otitis media, mononeuritis multiplex, and acute renal failure.
abstract: In December 2008, a 69-year-old Japanese woman was admitted to the Department of Otorhinolaryngology because of hearing impairment due to bilateral exudative otitis media, and was discharged without complete recovery despite conventional treatment. Two weeks later, she was readmitted for worsened deafness, numbness, gait disturbance, and general fatigue. She was referred to our department for general investigation. On admission, laboratory examination revealed severe inflammatory signs and active nephritic urinary sediments. Cranial computed tomography (CT) revealed progressive exudative otitis media and sinusitis. Initially, Wegener's granulomatosis was suspected. Nasal cavity biopsy, however, showed no granuloma formation or vasculitis. Serology revealed high titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA), suggestive of microscopic polyangitis (MPA). However, contrast CT identified stenosis of a celiac artery, and renal biopsy showed tubulointerstitial changes with minor glomerular abnormalities. Therefore, polyarteritis nodosa (PAN) was suspected and treatment with intravenous methylprednisolone was initiated. However, a lacunar infarct developed followed by cerebral hemorrhage, and the patient died 19 days after readmission. Autopsy revealed fibrinoid necrosis, neutrophilic infiltration, and giant cell reaction in small to medium-sized arteries in multiple organs. These findings led to diagnosis of systemic vasculitis anatomically compatible with PAN. This was a rare case of a patient with MPO-ANCA-positive PAN who may have developed bilateral exudative otitis media and hearing loss as the initial manifestation of PAN.
authors: Division of Nephrology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.
authors: Takeshi
authors: T
authors: Yamamoto
authors: Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan.
authors: Jun
authors: J
authors: Matsuda
authors: Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan.
authors: Hiroyuki
authors: H
authors: Kadoya
authors: Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan.
authors: Daisuke
authors: D
authors: Mori
authors: Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan.
authors: Daisuke
authors: D
authors: Ito
authors: Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors: Tomoko
authors: T
authors: Namba
authors: Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan.
authors: Masanobu
authors: M
authors: Takeji
authors: Division of Nephrology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.
authors: Megumu
authors: M
authors: Fukunaga
authors: Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan. ayamauchi@orh.go.jp.
authors: Atsushi
authors: A
authors: Yamauchi
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