A Case of Suspected Wegener's Granulomatosis Beginning with Repeated Attacks of Vertigo

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A 64-year-old woman consulted our hospital complaining of repeated attacks of vertigo over a six-year. We diagnosed granulomatous angiitis because P-ANCA titers were positive, CT and MRI examinations demonstrated granulation in the middle ear and histopathological study of the kidney demonstrated crescentic glomerulonephritis. We therefore administered the same treatment as for Wegener's granulomatosis but did not use immunosuppressive drugs.Prior to treatment, the frequency of her vertigo attacks had gradually increased and mixed (conductive and sensorineural) hearing loss appeared. We considered these symptoms were mainly due to infection, which can trigger worsening of Wegener's granulomatosis. We therefore first administered antibiotics, then prednisolone (PSL) and sulfamethoxazole and trimethoprim (ST) complex drugs.Cyclophosphamide (CY) was not used even though it has effects on autoimmune disease, since it may promote infectious disease.In such patients, it is important to determine whether autoimmune disease should first be treated with PSL and CY or infection should first be treated with antibiotics.
耳鼻咽喉科臨床学会の論文