Progressive hearing loss as the leading sign of Wegener’s granulomatosis

Marcin Grzegorz Dębski, Katarzyna Życińska, Marek Czarkowski, Małgorzata Żukowska, Kazimierz A. Wardyn, Ewa Bar-Andziak

Abstract
57-year-old woman with a history of ischaemic heart disease, arterial hypertension and after myocardial infarction was admitted to the uniwersity hospital because of progressive hearing loss and fever of unknown origin. Shortly before hospitalization she developed cough, hameoptisisand conjunctivitis. On the basis of clinical presentation Wegener’s granulomatosis was suspected. To confirm the diagnosis, CT scans of the chest, sinuses and ears were performed and revealed massive lesions especially in tht tympanic cavity, mastoid antrum and cells. Infiltrations were also observed in sinuses, especially maxillary, and typical granuloms were found in the lungs. Moreover, the biopsy taken from the mucous membrane of the nose showed abnormalities typical of Wegener’s granulomatosis. Antineutrophil cytoplasmatic antibodies (ANCA) were also examined. It is of interest that c-ANCA (cytoplasmatic) were negative and p-ANCA (perinuclear) were positive which is rare in this disease. The patient was treated with immunosuppressive drugs (intravenous methylprednisolon, oral prednisolon and cyclophosphamide). Following therapy fever, hemoptisis and conjuctivitis subsided, while inflamantory parameters normalized. This case report presents on unusual clinical manifestation of Wegener’s granulomatosis with the leading sign of hearing loss.

Keywords
fever of unknown origin, hearing loss, Wegener’s granulomatosis

Pol Arch Med Wewn, 2007; 117 (5-6): 266-269

PMID: 18030878

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