難治性中耳炎初発のウェゲナー肉芽腫症例

  • 八木澤 瑞穂
    横浜市立大学医学部附属市民総合医療センター耳鼻咽喉科
  • 石戸谷 淳一
    横浜市立大学医学部附属市民総合医療センター耳鼻咽喉科
  • 佐久間 康徳
    横浜市立大学医学部附属市民総合医療センター耳鼻咽喉科
  • 吉田 高史
    横浜市立大学医学部耳鼻咽喉科学教室
  • 佃 守
    横浜市立大学大学院医学研究科頭頸部生態機能・病態医科学

書誌事項

タイトル別名
  • Wegener's Granulomatosis of the Ear: Case Report
  • リンショウ ナンジセイ チュウジエン ショハツ ノ ウェゲナー ニクゲシュ ショウレイ

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抄録

Wegener's granulomatosis is a rare autoimmune disease affecting predominantly the nose or paranasal sinuses. Other organs of the upper air way may, however, be involved either alone or as parts of generalized disease. Occasionally the otological manifestation is the first and only sign of Wegener's granulomatosis.<br>In this case report we describe Wegener's granulomatosis in a 43-year-old female who complained of right aural discharge. Treatment for otitis media with systemic antibiotics was not effective, and due to persistent headache accompanied by mixed hearing loss, mastoidectomy was performed two months after the initial presentation. Histological examinations revealed granulomatous tissue in the mastoid, showing non-specific granulomatous inflammation. After operation, she developed painful gingival swelling and nasal obstruction. Finally, the patient was diagnosed with Wegener's granulomatosis based on the clinical, histological, and laboratory findings.<br>Since it is often difficult to confirm the diagnosis histologically, especially in limited types of Wegener's granulomatosis, we consider it better to rely on a test for C-ANCA when positive histological findings are not observed in the biopsy specimens.<br>The diagnosis should be considered in patients with otitis media that are unresponsive to conventional treatment.

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