Abstract
We report four cases of Wegener's granulomatosis (WG). Two cases appeared initially with otitis media, and the other two presented with nasal symptoms. Our experience suggests guidelines for early diagnosis of WG. An otitis media resistant to antibiotic therapy, a nasal septal perforation, and a saddling of the nose are suspicious for WG. In serological testing, highly elevated ESR, strongly positive CRP, positive RA test, and increased serum fibrinogen are often found in WG. Anti-neutrophil cytoplasmic antibody (ANCA) is highly specific for WG (>95%), therefore it is useful for diagnosis of that condition. The main histopathologic features of WG are multinucleated giant cells, extensive necrosis, vasculitis, and infiltration of inflammatory cells (especially neutrophils).
