A rare manifestation of a Wegener's granulomatosis

Introduction The otorhinolaryngologist is sometimes confronted with a complex of symptoms that makes prompt diagnosis difficult.Interdisciplinary collaboration can help significantly.

Case report A 22-year old patient with suspected otoliquorrhea following septoplasty,paracentesis and insertion of a tympanostomy tube as well as mastoidectomy alio loco was admitted to the hospital. Re-mastoidectomy was performed with no sign for a cerebrospinal fluid fistula. Afterwards the patient developed urinary retention,a numbness in the genital area,neck pain,subfebrile temperature and a hearing loss on the contralateral ear.Liquor puncture revealed no signs for a meningitis.MRI-scans of the spine and cranial CT-scans were without pathological findings.Neurosurgical examination could exclude a conus-cauda-syndrome.Then the patient developed a peripheral facial paresis grade III.Comprehensive diagnostics was initiated.cMRT could exclude a central cause for the paresis.A paracentesis on the contralateral ear was performed because the eardrum was reddened and thickened. Furthermore the patient's mother reported about a tuberculosis treatment 3 years ago following a stay abroad. A germ isolation was not successful at that time. Based on this information a CT scan of the thorax was performed and showed bilateral lung caverns, the sputum, however, was without microscopic detection of tubercle bacilli.

Conclusion The granulomatosis with polyangiitis is a chamaeleon and an autoimmune disorder.First symptoms occur frequently in the nose or ear area.The diagnosis is confirmed by detection of ANCAs and by histological examination.The disease can affect nearly any organ.The treatment is to induce remission with immunosuppressants usually by immunologists.

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Publication History

Article published online:
10 June 2020