2020 Volume 30 Issue 2 Pages 104-111
We report 2 cases of atypical otitis media with ANCA-associated vasculitis (OMAAV) that were treated with antibacterial agents and ventilation tube insertion.
The patient in case 1 was an 80-year-old woman diagnosed with bilateral otitis media with effusion (OME) and treated with ventilation tube insertion. She was referred to our hospital because her hearing progressively worsened. She had been suffering from diabetes mellitus for a long time, and Pseudomonas aeruginosa was detected in the purulent otorrhea, suggestive of malignant external otitis. After intravenous administration of meropenem, the Pseudomonas infection was well controlled; however, CRP and leukocytosis did not improve. Therefore, we decided to use a high dose of steroids for the diagnosis and treatment of OMAAV. After intravenous administration of 60 mg/day of prednisone, otorrhea, decreased rapidly and the eardrum finding gradually improved. Finally, OMAAV was confirmed as the patient tested positive for MPO-ANCA during treatment.
The patient in case 2 was a 71-year-old woman diagnosed with bilateral OME and treated with ventilation tube insertion. Serious and pulsatile otorrhea was spouting from the ventilation tubes at the initial visit, but bacteria were not detected in the otorrhea. OMAAV was suspected because CRP was high and bilateral hearing was profoundly deteriorated. She tested positive for MPO-ANCA and was treated with a high dose of steroids. Otorrhea and hearing recovered rapidly.
Diagnosis of OMAAV is sometimes difficult in its early stages and in atypical cases. Recovery of hearing is difficult when it progresses profoundly; therefore, we should screen for OMAAV in cases of intractable otitis media.
