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Selected Publication:
Hofmann, T; Kainz, J; Koc, C; Smolle, KH; Brunner, G.
Isolated unilateral otitis with facial nerve paralysis as initial symptom of Wegener granulomatosis. An unusual clinical course].
Laryngorhinootologie. 1998; 77(6):352-354
Doi: 10.1055/s-2007-996987
(- Case Report)
Web of Science
PubMed
FullText
FullText_MUG
- Leading authors Med Uni Graz
- Hofmann Thiemo
- Co-authors Med Uni Graz
- Brunner Gernot
- Kainz Josef
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- Abstract:
- Wegener's granulomatosis is an immunepathogenic disease of unknown origin. The histopathological picture shows granulomatous inflammation with epitheloid cells, granulomas, and general vasculitis. The diagnosis of Wegener's granulomatosis is made on the basis of the clinical picture, serum cANCA, and histologic examination of biopsies. Patient: We present the case of a 57-year-old white male patient who was admitted to our ENT Hospital with a six weeks' history of otalgia and incomplete ipsilateral facial palsy since the day before admission. The patient had clinical features of acute otitis media without signs of mastoiditis. Despite a ten days' course of intravenous antibiotic treatment, the intensity of facial palsy progressed and the general condition of the patient worsened. A mastoidectomy and decompression of the facial nerve were performed, demonstrating sclerosis of the mastoid cells. Three weeks after release from the hospital, the patient was admitted again with recurrent fever, cephalea, loss of weight, and arthritic pain. There were no signs of recurrent otitis media or mastoiditis, and sigmoid sinus thrombosis was ruled out. Even under aggressive, intravenous antibiotic treatment the general physical condition continued to worsen; septic temperatures and signs of beginning renal failure occurred. The patient was transferred to the ICU with the diagnosis of sepsis of unknown origin. There bloodtests were positive for cANCA, which is highly specific for Wegener's granulomatosis. Under therapy with cyclophosphamide and IV corticosteroid, the patient recovered within 14 days. Conclusion: The lack of symptoms in the upper respiratory tract in our patient was unusual, indicating that in patients with recurrent otitis media, facial palsy, mastoiditis, or external otitis Wegener's granulomatosis should be ruled out as differential diagnosis.
- Find related publications in this database (using NLM MeSH Indexing)
- Antibodies, Antineutrophil Cytoplasmic - blood
- Decompression, Surgical -
- Diagnosis, Differential -
- Facial Nerve - pathology Facial Nerve - surgery
- Facial Paralysis - etiology Facial Paralysis - pathology Facial Paralysis - surgery
- Humans -
- Male -
- Mastoid - pathology Mastoid - surgery
- Middle Aged -
- Otitis Media - etiology Otitis Media - pathology Otitis Media - surgery
- Recurrence -
- Wegener Granulomatosis - diagnosis Wegener Granulomatosis - pathology Wegener Granulomatosis - surgery
- Find related publications in this database (Keywords)
- Wegener's granulomatosis
- otitis media-delayed diagnosis
- facial palsy
- cANCA