caa a22 4500 44588357X CHVBK 20180317145552.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1007/s10157-011-0457-6 doi (NATIONALLICENCE)springer-10.1007/s10157-011-0457-6 A case of MPO-ANCA-positive polyarteritis nodosa complicated by exudative otitis media, mononeuritis multiplex, and acute renal failure [Elektronische Daten] [Takeshi Yamamoto, Jun Matsuda, Hiroyuki Kadoya, Daisuke Mori, Daisuke Ito, Tomoko Namba, Masanobu Takeji, Megumu Fukunaga, Atsushi Yamauchi] In December 2008, a 69-year-old Japanese woman was admitted to the Department of Otorhinolaryngology because of hearing impairment due to bilateral exudative otitis media, and was discharged without complete recovery despite conventional treatment. Two weeks later, she was readmitted for worsened deafness, numbness, gait disturbance, and general fatigue. She was referred to our department for general investigation. On admission, laboratory examination revealed severe inflammatory signs and active nephritic urinary sediments. Cranial computed tomography (CT) revealed progressive exudative otitis media and sinusitis. Initially, Wegener's granulomatosis was suspected. Nasal cavity biopsy, however, showed no granuloma formation or vasculitis. Serology revealed high titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA), suggestive of microscopic polyangitis (MPA). However, contrast CT identified stenosis of a celiac artery, and renal biopsy showed tubulointerstitial changes with minor glomerular abnormalities. Therefore, polyarteritis nodosa (PAN) was suspected and treatment with intravenous methylprednisolone was initiated. However, a lacunar infarct developed followed by cerebral hemorrhage, and the patient died 19days after readmission. Autopsy revealed fibrinoid necrosis, neutrophilic infiltration, and giant cell reaction in small to medium-sized arteries in multiple organs. These findings led to diagnosis of systemic vasculitis anatomically compatible with PAN. This was a rare case of a patient with MPO-ANCA-positive PAN who may have developed bilateral exudative otitis media and hearing loss as the initial manifestation of PAN. Japanese Society of Nephrology, 2011 Vasculitis nationallicence Wegener's granulomatosis nationallicence Hearing loss nationallicence Yamamoto Takeshi Division of Nephrology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan aut Matsuda Jun Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut Kadoya Hiroyuki Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut Mori Daisuke Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut Ito Daisuke Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut Namba Tomoko Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan aut Takeji Masanobu Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut Fukunaga Megumu Division of Nephrology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan aut Yamauchi Atsushi Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut Clinical and Experimental Nephrology Springer Japan 15/5(2011-10-01), 754-760 1342-1751 15:5<754 2011 15 10157 https://doi.org/10.1007/s10157-011-0457-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10157-011-0457-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Yamamoto Takeshi Division of Nephrology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan aut NATIONALLICENCE 700 1- Matsuda Jun Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut NATIONALLICENCE 700 1- Kadoya Hiroyuki Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut NATIONALLICENCE 700 1- Mori Daisuke Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut NATIONALLICENCE 700 1- Ito Daisuke Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut NATIONALLICENCE 700 1- Namba Tomoko Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan aut NATIONALLICENCE 700 1- Takeji Masanobu Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut NATIONALLICENCE 700 1- Fukunaga Megumu Division of Nephrology, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan aut NATIONALLICENCE 700 1- Yamauchi Atsushi Division of Nephrology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Osaka, Japan aut NATIONALLICENCE 773 0- Clinical and Experimental Nephrology Springer Japan 15/5(2011-10-01), 754-760 1342-1751 15:5<754 2011 15 10157 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer