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. 2017;55(5):256-260.
doi: 10.5114/reum.2017.71643. Epub 2017 Oct 28.

Two clinical cases of granulomatosis with polyangiitis with isolated otitis media and mastoiditis

Georgi Kukushev  1 , Desislava Kalinova  2 , Ivan Sheytanov  2 , Rasho Rashkov  2
Affiliations

Two clinical cases of granulomatosis with polyangiitis with isolated otitis media and mastoiditis

Georgi Kukushev et al. Reumatologia. 2017.

Abstract

Granulomatosis with polyangiitis (GPA) is characterised by granulomatous necrotising inflammatory lesions of the upper and lower respiratory tract, often associated with pauci-immune glomerulonephritis. The diagnosis of granulomatosis with polyangiitis is made according to the classification criteria of the ACR criteria for granulomatosis with polyangiitis. We present two cases of granulomatosis with polyangiitis limited/localised form. The common feature between two clinical cases were not sufficient criteria for a definite diagnosis at the beginning. In both cases the clinical presence was otitis media with acute mastoiditis, peripheral facial nerve palsy, and severe headache. Early diagnosis and treatment of patients with granulomatosis with polyangiitis define favourable prognosis. On the other hand, the treatment of granulomatosis with polyangiitis (corticosteroids and immunosuppressive therapy) has various side effects, and the "ex juvantibus" therapy is hazardous.

Keywords: granulomatosis with polyangiitis; mastoiditis; otitis media.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Computed tomography of the head. Left mastoiditis and inflammation in the left middle ear cavity.
Fig. 2
Fig. 2
Fragments of soft tissues, some covered with stratified (flattened) squamous epithelium with extensive zones of oedema, haemorrhage, and necrosis, and marked granulomatous necrotizing inflammation. In the central area of the granuloma, necrosis and a cluster of lymphocytes were found without multinucleated giant cells. A) HE, original magnification 10 ×; B) HE, original magnification 20 ×; C) HE, original magnification 10 ×.
Fig. 3
Fig. 3
Central perforation of the tympanic membrane of the left ear (A). Granulation in the left nasal cavity (in front of the inferior turbine) (B). Conjunctival granulation (C). Granulations in the epipharynx (D).
See this image and copyright information in PMC

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