抄録
A 30-year-old woman suffering from subglottic stenosis due to Wegener's granulomatosis (WG) was reported. She first visited us in 1982 because of exudative otitis media (EOM) on the right. The saddle nose and crusting in the nasal cavity gradually became apparent in 1990. Subsequently, she developed left EOM in 1993. Repeated examinations showed no inflammatory signs and negative titer of cytoplasmic pattern of antineutrophil cytoplasmic antibody (CANCA). In January, 1995, she suddenly developed severe dysphonia and exertional dyspnea. Laryngoscopy revealed marked swelling of the subglottic mucosa. Histologic examination of the nasal mucosa revealed vasculitis, lymphocyte infiltration, and foreign body giant cells, and CANCA was found positive. Thus, thirteen years after onset, the diagnosis was established as WG. She was given prednisolone (PSL) at 60mg/day for five days, which greatly relieved her of the subglottic stenosis. Administration of PSL was then tapered to 5 mg/day.
Cyclophosphamide (CPM) was not given to her. Although combination of PSL and CPM therapy greatly contributed improvement of life prognosis in patients with generalized WG, this treatment might be too aggressive to the patients with WG limited to the head and neck region because of unfavorable drug side effects such as increased occurrences of infection and cancer of the urinary bladder. Since subglottic stenosis is troublesome to treat surgically, it is indispensable to diagnose WG in its early stage in order to start appropriate medical treatment for improvement of the stenosis.
